HIMSS Immunization Integration Program CDC Test Plan v10.5

This test plan is to be used for the testing of the HIMSS Immunization Integration Program: Immunization-Related Capabilities and Guidance developed under a cooperative agreement with the American Immunization Registry Association (AIRA) and the Centers for Disease Control and Prevention (CDC). All test cases are required to be executed. The test plan includes both functional and interoperability tests including Vaccine Update Notifications (HL7 V2.5.1 VXU/Z22) and Query and Response (Evaluated History and Forecast Group Z44/Z42). See release notes.

Test Story

Description

Comments

Pre-condition

Post-Condition

Test Objectives

Evaluation Criteria

Notes

1. Initial Data Load

The initial data load will consist of the vendor entering data during live interactive testing for five (5) patients with various scenarios. The data entry will include demographic data, immunization histories and specific conditions for each patient. The initial data load will also populate the inventory used in the use case.

Test Story

Description

Comments

Pre-condition

Post-Condition

Test Objectives

Evaluation Criteria

Notes

1.1. Juana Mariana Vazquez Initial Data Load

Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for a school-aged child Juana Mariana Vazquez. There are no transactions associated with this test case.

Test Story

Description

The practice site for the scenario is Shoreline Pediatrics. The EHR vendor loads demographic data and clinical history for Juana Mariana Vazquez. The data includes immunizations provided by the practice.

The vendor also enters:

-Two vaccines administered at other sites

1. an influenza vaccine given at a local pharmacy

2. an inactivated polio vaccine given elsewhere and not reported to the registry - the history includes an adverse reaction (febrile seizure) 8 hours after the vaccine was administered

- Adverse reaction to inactivated polio vaccine (febrile seizure) and the date and source of information

NOTE: the historical vaccines will be imported during the Registry query (e.g. from another practice).



Comments

Set-up step evaluating EHR functions for capturing and storing patient pediatric demographic data, historical immunizations, and clinical conditions. There is no transaction associated with this test step.


Pre-condition

No Pre-Condition


Post-Condition

The EMR has recorded all of the pediatric demographic data, historical immunizations, and clinical conditions in the record created for Juana Mariana Vazquez using the test data provided.


Test Objectives

Register New Patients: The EHR or other clinical software system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. The EHR or other clinical software system must be able to store information to successfully match with patients in immunization registries, if the information is available. Specific to immunization registries, that information includes the mother's maiden name, whether the patient was part of a multiple birth, and the birth order (i.e., ordinal number of birth, first, second, etc.). This information allows the provider to correctly identify the patient and also helps ensure a match when the EHR sends the patient's information to external systems such as an immunization registry.

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Request/Receive Patient Immunization Data and Identify Source: The EHR stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.

Data Quality Checks: The EHR or other clinical software system Integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

  • 2104 : Indicates that a historical dose is being reported for the current date.
  • 2204 : Indicates that the administration being reported occurred too far in the past.


Supporting data for:

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient (Return Evaluated Immunization History and Forecast (Z42) – HL7 Version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5). The EHR is able to display the evaluated immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if they choose to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


1.1.1. Enter Initial Demographic Data for New Patient Juana Mariana Vazquez

Test Step Type: SUT_MANUAL
Juana Mariana Vazquez is entered as a patient in the EHR, including all pediatric demographic information.

Test Story

Description

The EHR vendor loads demographic data for Juana Mariana Vazquez.


Comments

Set-up step evaluating EHR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.


Pre-condition

No Pre-Condition


Post-Condition

The EHR has recorded all of the pediatric demographic in the record created for Juana Mariana Vazquez.


Test Objectives

Register New Patients: The EHR or other clinical software system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. The EHR or other clinical software system must be able to store information to successfully match with patients in immunization registries, if the information is available. Specific to immunization registries, that information includes the mother's maiden name, whether the patient was part of a multiple birth, and the birth order (i.e., ordinal number of birth, first, second, etc.). This information allows the provider to correctly identify the patient and also helps ensure a match when the EHR sends the patient's information to external systems such as an immunization registry.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]. The code values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the specified coded value when the attribute is conveyed in later transaction messages.

For systems that document vaccine program eligibility at the patient level: VFC Eligible

To minimize data entry, the ADT A04 message below the data table may be used to automate data entry. If this option is used, the proctor will review the ability of the system to record, modify, and store these attributes.


Patient ID (previously listed as "Medicaid Number")
Vendor supplied
Y
Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name
Shoreline Pediatrics
Y
Patient ID: Type (e.g., medical record number, IIS ID)
Vendor supplied
Y
Patient Name: First
Juana
Y
Patient Name: Middle
Mariana
Y
Patient Name: Last
Vazquez
Y
Patient Date of Birth
11/01/2017
Y
Birth Time
11:05 am
N
Patient Gender (Administrative Sex)
F
Y
Patient Multiple Birth Indicator
No
Y
Patient Birth Order
N/A
C
Responsible Person Name: First
Joanna
Y
Responsible Person Name: Middle
Merida
Y
Responsible Person Name: Last
Vazquez
Y
Responsible Person Name: Relationship to Patient
Grandparent
Y
Mother's Name: First
Maria
Y
Mother's Name: Middle
Merida
Y
Mother's Name: Last
Vazquez
Y
Mother's Name: Maiden Last
Acosta
Y
Patient Address: Street
4345 Standish Way
Y
Patient Address: City
Stamford
Y
Patient Address: State
CT
Y
Patient Address: Country
USA
Y
Patient Address: Zip code
06903
Y
Race
White
Y
Ethnicity
Hispanic or Latino
Y
Patient Primary Language
English
Y
Patient Telephone Number
(203) 555-1212
Y
Patient Telephone Number Type (e.g., home, cell)
Cell
Y
Patient E-mail Address
jmg@gmail.com
N
Publicity Code
Reminder/recall - any method (02 HL70215)
Y
Publicity Code Effective Date
11/01/2017
Y
Protection Indicator
N
Y
Protection Indicator Effective Date
11/01/2017
Y
Immunization Registry Status
Active
Y
Preferred Contact Method
Text
Y


ADT A04 Message:

MSH|^~\&|Test EHR Application|X68||NIST Test Iz Reg|20221031082240-0500||ADT^A04^ADT_A01|NIST-IZ-001.00|P|2.5.1|||ER|AL|||||

EVN|A04|202210310822|202210310822|01||202210310822

PID|1||123456^^^MYEHR^MR~987633^^^MYIIS^SR||Vazquez^Juana^Mariana^^^^L|Acosta^Maria^Merida^^^^M|201711011105|F||2106-3^White^CDCREC|4345 Standish Way^^Stamford^CT^06903^USA^L||^PRN^CP^^1^203^5551212~^NET^^jmg@gmail.com||eng^English^ISO639|||||||2135-2^Hispanic or Latino^CDCREC||N

PD1|||||||||||02^Reminder/Recall - any method^HL70215|N|20171101|||A|20171101|20171101

NK1|1|Vazquez^Joanna^Merida^^^^L|GRP^Grandparent^HL70063|4345 Standish Way^^Stamford^CT^06903^^L|^PRN^CP^^1^203^5551212~^NET^^jmg@gmail.com

PV1||O|||||^Smith^Frank^^^^^^^L^^^^^^^^^^^MD|^Smith^Frank^^^^^^^L^^^^^^^^^^^MD| ||||||||||||||||||||||||||||||SP^Shoreline Pediatrics^HL70362||||||


Notes

Publicity Code is included in order to support documentation of communication method for the TestCaseGroup:Cohort Report. If the EHR does not support this attribute, the result for this step may indicate pass, but the lack of support should be documented as a notable exception.

The date/time of birth for the twins includes birth time. This aids in distinguishing the birth order for multiple births. Since this patient is not a multiple birth, the vendor can pass with notable exception if the birth date/time does not include precision of birth time. The notable exception should document the lack of support for birth time.

While the PID indicates that it is Vendor Supplied, the ID returned from the registry query is: 123456^^^MYEHR^MR~987633^^^MYIIS^SR. The IIS will not know the PID of the local system, and there is no context-based validation checking for the PID.

Registry status of' 'Active' is required when sending a VXU to the IIS which will be done for this patient.

Manual entry of one of the patient demographics and clinical history will be required (or reviewed) to ensure that entry of the required fields is possible.


1.1.2. Enter Initial Immunization Data for Juana Mariana Vazquez: Immunizations from Practice

Test Step Type: SUT_MANUAL
Patient History from the local practice is entered into the EHR.

Test Story

Description

The EHR vendor loads immunization history data from the local practice for Juana Mariana Vazquez. This includes an MMR dose that was given too early. This MMR dose serves to seed checking for dose given too early in TestCaseGroup: Juana Mariana Vazquez Visit, TestCase: Query the Registry for Juana Mariana Vazquez, TestStep: Mark first MMR Dose as Invalid.


Comments

No Comments


Pre-condition

The EHR has recorded all of the pediatric demographic data in the record created for Juana Mariana Vazquez.


Post-Condition

The EHR has recorded all of the pediatric demographic data in the record created for Juana Mariana Vazquez.


Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.


Request/Receive Patient Immunization Data and Identify Source: The EHR stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.


Supporting data for:

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient (Return Evaluated Immunization History and Forecast (Z42) – HL7 Version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5). The EHR is able to display the evaluated immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if they choose to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.

 

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization data known to the local practice as provided, with all required attributes indicated by [Y]. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

Vaccine from Practice - HepB


Entered By
Sandra Molina
Y
Ordering Provider
Frank Smith
N
Entering Organization
Shoreline Pediatrics
Y
Administration Notes (Vaccine Event information source)
New immunization record (NIP001 00)
Y
Date/Time of Start of Administration
12/20/2017
Y
Vaccine Administered
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08, NDC 58160-0820-43)
Y
Administered Amount (of Vaccine)
0.5
Y
Administered Units (of Measure)
mL
Y
Administering Provider
Sandra Molina
N
Administered-at Location
400 Shoreline Drive, Stamford Connecticut 06901
N
Lot Number
6352FK1
Y
Substance Expiration Date
12/31/2017
Y
Substance Manufacturer Name
GlaxoSmithKline Biologicals SA (MVX SKB)
Y
Completion Status
Completed (CP)
Y
Route of Administration
Intramuscular (NCIT: C28161, HL70162: IM)
Y
Administration Site
Left Thigh (HL70163: LT)
Y



Vaccine from Practice – MMR


Entered By
Sandra Molina
Y
Ordering Provider
Frank Smith
N
Entering Organization
Shoreline Pediatrics
Y
Vaccine Event information source
New immunization record (NIP001 00)
Y
Date/Time of Start of Administration
08/22/2018
Y
Vaccine Administered
Measles, mumps, rubella virus vaccine
(CVX 03, NDC 00006-4681-01)
Y
Administered Amount (of Vaccine)
0.5
Y
Administered Units (of Measure)
mL
Y
Administering Provider
Sandra Molina
N
Administered-at Location
400 Shoreline Drive, Stamford Connecticut 06901
N
Lot Number
0853CC
Y
Substance Expiration Date
12/15/2018
Y
Substance Manufacturer Name
Merck and Co Inc (MVX MSD)
Y
Completion Status
Completed (CP)
Y
Route of Administration
Subcutaneous (NCIT C38299, HL70162: SC)
Y
Administration Site
Left Thigh (HL70163 LT)
Y




Notes

The MMR dose serves to seed checking for dose given too early in TestCaseGroup: Juana Mariana Vazquez Visit, TestCase: Query the Registry for Juana Mariana Vazquez, TestStep: Mark first MMR Dose as Invalid.

The EHR does not need to specify a 'new immunization', as long as there is a way to indicate that it is a new immunization within the EHR, this is acceptable (e.g. the default interpretation of the data entry is that it is a new immunization and not historical).


1.1.3. Enter Initial Immunization Data for Juana Mariana Vazquez from Another Practice

Test Step Type: SUT_MANUAL
Patient History from another practice is entered into the EHR.

Test Story

Description

The EHR vendor loads immunization history data from another practice into the record for Juana Mariana Vazquez.


Comments

No Comments


Pre-condition

The EHR has recorded all of the pediatric demographic data in the record created for Juana Mariana Vazquez.


Post-Condition

The immunization history from another practice is loaded into the record created for Juana Mariana Vazquez.


Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

 

Request/Receive Patient Immunization Data and Identify Source: The EHR stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.


Supporting data for:

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient (Return Evaluated Immunization History and Forecast (Z42) – HL7 Version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5). The EHR is able to display the evaluated immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if they choose to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization history data from another practice as provided, with all required attributes indicated by [Y]:


Historical Vaccine from Another Practice – DTaP


Entered By
Sandra Molina
Y
Ordering Provider
J. Rodriguez
N
Entering Organization
Shoreline Pediatrics
Y
Vaccine Event information source (Administration Notes)
Historical information – from other provider (NIP001 02)
Y
Date/Time of Start of Administration
11/20/2021
Y
Vaccine Administered
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) (NDC 49281-0286-58)
Y
Administered Amount (of Vaccine)
0.5
Y
Administered Units (of Measure)
mL
Y
Administering Provider
Linda Casera
N
Administered-at Location
4253 Standish Way, Stamford Connecticut 06903
N
Lot Number
D643QS8243
Y
Substance Expiration Date
12/1/2021
Y
Substance Manufacturer Name
Sanofi Pasteur Inc (MVX PMC)
Y
Completion Status
Completed (CP)
Y
Route of Administration
Intramuscular (NCIT: C28161, HL70162 IM)
Y
Administration Site
Left Deltoid (HL70163: LD)
Y
Historical Vaccine from Another Practice – Polio


Entered By
Sandra Molina
Y
Ordering Provider
J. Rodriguez
N
Entering Organization
Shoreline Pediatrics
Y
Vaccine Event information source
Historical information – from other provider (NIP001 02)
Y
Date/Time of Start of Administration
2/21/2019
Y
Vaccine Administered
poliovirus vaccine, inactivated (CVX 10) (NDC 49281-0860-88)
Y
Administered Amount (of Vaccine)
0.5
Y
Administered Units (of Measure)
mL
Y
Administering Provider
Linda Casera
N
Administered-at Location
4253 Standish Way, Stamford Connecticut 06903
N
Lot Number
D335PV9644
Y
Substance Expiration Date
4/22/2019
Y
Substance Manufacturer Name
Sanofi Pasteur Inc (MVX PMC)
Y
Completion Status
Completed (CP)
Y
Route of Administration
Subcutaneous (NCIT: C28161, HL70162 SC)
Y
Administration Site
Left Arm (HL70163: LA)
Y
Reaction
Adverse Reaction of (VXC12^fever of >40.5C (105F) within 48 hours of dose^CDCPHINVS)
Y



Notes

No Note


1.1.4. Attempt to enter vaccination too long ago for Juana Mariana Vazquez

Test Step Type: SUT_MANUAL
A historical vaccination is identified as too long ago.

Test Story

Description

The provider attempts to enter immunization data with a data entry error and is alerted that the date identified is too long ago, in this case, before birth. 



Comments

This situation may arise where the vaccination date on the materials provided was misread.


Pre-condition

The EHR has recorded all of the pediatric demographic data in the record created for Juana Mariana Vazquez.


Post-Condition

The provider has been alerted that the vaccination date was too long ago.


Test Objectives

Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

2204: Indicates that the administration being reported occurred too far in the past.


Evaluation Criteria

Evaluation Criteria: During the course of data entry for information below, the EHR triggers the following data quality issues:

1. Triggers error that the vaccination date entered was too long ago (2204)


Historical Vaccine from Pharmacy
Reported by Parent – Influenza


Entered By
Sandra Molina
N
Ordering Provider
Gina Ricci
N
Entering Organization
Shoreline Pediatrics
N
Vaccine Event information source (Administration Notes)
Historical information – from parent’s written record (NIP001 03)

Date/Time of Start of Administration
10/15/2017
Y – Triggers error that the vaccination date entered was too long ago
Will be corrected to current date
Vaccine Administered
Influenza, injectable, quadrivalent, preservative free (CVX 150) FLUARIX QUADRIVALENT (NDC 58160-0890-41)
May also trigger error that the NDC is not valid for 2017, but the key error is related to the administration date/time
Administered Amount (of Vaccine)
0.5
N
Administered Units (of Measure)
mL
N
Administering Provider
Gina Ricci
N
Administered-at Location
Oceanview Pharmacy, 15 Post Road, Stamford Connecticut 06901
N
Lot Number
8L4B3423
N
Substance Expiration Date
12/30/2017
N
Substance Manufacturer Name
GlaxoSmithKline (MVX SKB)
N
Completion Status
Completed (CP)
N
Route of Administration
Intramuscular (NCIT: C28161, HL70162: IM)
N
Administration Site
Left Deltoid (HL70163: LD)
N

 



Notes

Full vaccination details are provided, but only the minimum data entry necessary to trigger the alert is required for this test step as determined by the vendor. This same information with the correct date will be entered in later in this test case.


1.1.5. Attempt to enter historical vaccination for current date for Juana Mariana Vazquez

Test Step Type: SUT_MANUAL
A historical vaccination is documented for the current date and triggers a data quality alert.

Test Story

Description

The provider attempts to enter historical immunization for the current date and is alerted that of the possible data quality error.



Comments

No comment.


Pre-condition

The EHR has recorded all of the pediatric demographic data in the record created for Juana Mariana Vazquez.


Post-Condition

The provider has been alerted that the vaccination date for the historical administration was documented as the current date.


Test Objectives

Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

  -  2104: Indicates that a historical dose is being reported for the current date.


Evaluation Criteria

Evaluation Criteria: Vendor alerts provider that the historical vaccination date entered is the current date:

Historical Vaccine from Pharmacy
Reported by Parent – Influenza


Entered By
Sandra Molina
N
Ordering Provider
Gina Ricci
N
Entering Organization
Shoreline Pediatrics
Y
Vaccine Event information source (Administration Notes)
Historical information – from parent’s written record (NIP001 03)
N
Date/Time of Start of Administration
Current Date
Y
Vaccine Administered
Influenza, injectable, quadrivalent, preservative free (CVX 150) FLUARIX QUADRIVALENT (NDC 58160-0890-41)
Y
Administered Amount (of Vaccine)
0.5
N
Administered Units (of Measure)
mL
N
Administering Provider
Gina Ricci
N
Administered-at Location
Oceanview Pharmacy, 15 Post Road, Stamford Connecticut 06901
N
Lot Number
8L4B3423
N
Substance Expiration Date
12/30/2021
N
Substance Manufacturer Name
GlaxoSmithKline (MVX SKB)
N
Completion Status
Completed (CP)
N
Route of Administration
Intramuscular (NCIT: C28161, HL70162: IM)
N
Administration Site
Left Deltoid (HL70163: LD)
N

Notes

Full vaccination details are provided, but only the minimum data entry necessary to trigger the alert is required for this test step as determined by the vendor. This same information with the correct date will be entered in later in this test case.


1.1.6. Enter Initial Immunization Data for Juana Mariana Vazquez Reported by Parent

Test Step Type: SUT_MANUAL
Patient History from a pharmacy as reported by the parent is entered into the EHR.

Test Story

Description

The provider enters immunization data from a pharmacy as reported by the parent for Juana Mariana Vazquez.



Comments

No Comments


Pre-condition

The EHR has recorded all of the pediatric demographic data in the record created for Juana Mariana Vazquez.


Post-Condition

The immunization history from the pharmacy as reported by the parent is loaded into the record created for Juana Mariana Vazquez.


Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

 

Request/Receive Patient Immunization Data and Identify Source: The EHR stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.


Supporting data for:

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient (Return Evaluated Immunization History and Forecast (Z42) – HL7 Version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5). The EHR is able to display the evaluated immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if they choose to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization history data from the pharmacy as provided by the parent with all required attributes indicated by [Y]:

Historical Vaccine from Pharmacy Reported by Parent – Influenza


Entered By
Sandra Molina
Y
Ordering Provider
Gina Ricci
N
Entering Organization
Shoreline Pediatrics
Y
Vaccine Event information source (Administration Notes)
Historical information – from parent’s written record (NIP001 03)
Y
Date/Time of Start of Administration
10/15/2021
Y
Vaccine Administered
Influenza, injectable, quadrivalent, preservative free (CVX 150) FLUARIX QUADRIVALENT (NDC 58160-0887-41)
Y
Administered Amount (of Vaccine)
0.5
Y
Administered Units (of Measure)
mL
Y
Administering Provider
Gina Ricci
N
Administered-at Location
Oceanview Pharmacy, 15 Post Road, Stamford Connecticut 06901
Y
Lot Number
8L4B3423
Y
Substance Expiration Date
12/30/2021
Y
Substance Manufacturer Name
GlaxoSmithKline (MVX SKB)
Y
Completion Status
Completed (CP)
Y
Route of Administration
Intramuscular (NCIT: C28161, HL70162: IM)
Y
Administration Site
Left Deltoid (HL70163: LD)
Y

Notes

No Note


1.2. Juan Marcel Marina Initial Data Load

Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for 1 1/2-year old Juan Marcel Marina. There are no transactions associated with this test case.

Test Story

Description

The practice site for the scenario is Shoreline Pediatrics. The EHR vendor loads demographic data and clinical history for Juan Marcel Marina. The data includes a clinical history of varicella, and serological evidence of Hepatitis A immunity.



Comments

Set-up step evaluating EHR functions for capturing and storing patient pediatric demographic data, historical immunizations, and clinical conditions. There is no transaction associated with this test step.


Pre-condition

No Pre-Condition


Post-Condition

The EHR has recorded all of the pediatric demographic data, historical immunizations, and clinical conditions in the record created for Juan Marcel Marina using the test data provided.


Test Objectives

Register New Patients: The EHR or other clinical software system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. The EHR or other clinical software system must be able to store information to successfully match with patients in immunization registries, if the information is available. Specific to immunization registries, that information includes the mother's maiden name, whether the patient was part of a multiple birth, and the birth order (i.e., ordinal number of birth, first, second, etc.). This information allows the provider to correctly identify the patient and also helps ensure a match when the EHR sends the patient's information to external systems such as an immunization registry.

 

Supporting data for:

Modify Antigen Recommendations Based on Active Diagnoses: The EHR or other clinical software system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


1.2.1. Enter Initial Demographic Data for New Patient Juan Marcel Marina

Test Step Type: SUT_MANUAL
Juan Marcel Marina is entered as a patient in the EHR, including all pediatric demographic information.

Test Story

Description

The EHR vendor loads demographic data for Juan Marcel Marina.


Comments

Set-up step evaluating EHR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.


Pre-condition

No Pre-Condition


Post-Condition

The EHR has recorded all of the pediatric demographic in the record created for Juan Marcel Marina.


Test Objectives

Register New Patients: The EHR or other clinical software system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. The EHR or other clinical software system must be able to store information to successfully match with patients in immunization registries, if the information is available. Specific to immunization registries, that information includes the mother's maiden name, whether the patient was part of a multiple birth, and the birth order (i.e., ordinal number of birth, first, second, etc.). This information allows the provider to correctly identify the patient and also helps ensure a match when the EHR sends the patient's information to external systems such as an immunization registry.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

For systems that document vaccine program eligibility at the patient level: Not VFC Eligible

To minimize data entry, the ADT A04 message below the data table may be used to automate data entry. If this option is used, the proctor will review the ability of the system to record, modify, and store these attributes.



Patient ID (previously listed as “Medicaid Number”)
Vendor supplied
Y
Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name
Shoreline Pediatrics
Y
Patient ID: Type (e.g., medical record number, IIS ID)
Vendor supplied
Y
Patient Name: First
Juan
Y
Patient Name: Middle
Marcel
Y
Patient Name: Last
Marina
Y
Patient Date of Birth
03/04/2021
Y
Birth Time
11am
N
Patient Gender (Administrative Sex)
M
Y
Patient Multiple Birth Indicator
N
Y
Patient Birth Order
N/A
C
Responsible Person Name: First
Manuel
Y
Responsible Person Name: Middle
Marcel
Y
Responsible Person Name: Last
Marina
Y
Responsible Person Name: Relationship to Patient
Father
Y
Mother’s Name: First
Anita
Y
Mother’s Name: Middle
Francesca
Y
Mother’s Name: Last
Marina
Y
Mother’s Name: Maiden Last
Morales
Y
Patient Address: Street
4623 Standish Way
Y
Patient Address: City
Stamford
Y
Patient Address: State
CT
Y
Patient Address: Country
USA
Y
Patient Address: Zip code
06903
Y
Race
White
Y
Ethnicity
Hispanic or Latino
Y
Patient Primary Language
English
Y
Patient Telephone Number
(203) 555-1213
Y
Patient Telephone Number Type (e.g., home, cell)
Cell
Y
Patient E-mail Address
None
N
Publicity Code
Reminder/recall – no calls (03 HL70215)
Y
Publicity Code Effective Date
03/04/2021
Y
Protection Indicator
N
Y
Protection Indicator Effective Date
03/04/2021


Y
Immunization Registry Status
Active
Y
Preferred Contact Method
Text
Y


ADT A04 Message:

MSH|^~\&|Test EHR Application|X68||NIST Test Iz Reg|20221031082240-0500||ADT^A04^ADT_A01|NIST-IZ-001.00|P|2.5.1|||||||||

PID|1||123456^^^MYEHR^MR~987633^^^MYIIS^SR||Marina^Juan^Marcel^^^^L|Morales^Anita^Francesca^^^^M|202103041100|M||2106-3^White^CDCREC|4623 Standish Way^^Stamford^CT^06903^USA^L||^PRN^CP^^1^203^5551213||eng^English^ISO639|||||||2135-2^Hispanic or Latino^CDCREC||N

PD1|||||||||||03^Reminder/recall – no calls^HL70215|N|20210304|||A|20210304|20210304

NK1|1|Marina^Manuel^Marcel^^^^L|FTH^Father^HL70063|4623 Standish Way^^Stamford^CT^06903^^L|^PRN^CP^^1^203^5551213

PV1||O|||||^Smith^Frank^^^^^^^L^^^^^^^^^^^MD|^Smith^Frank^^^^^^^L^^^^^^^^^^^MD| ||||||||||||||||||||||||||||||SP^Shoreline Pediatrics^HL70362||||||

OBX|1|CE|51913-2^Hepatitis A virus IgG+IgM Ab [Presence] in Serum ^LN|1|260373001^Detected^SCT||||||F|||20220115

DG1|2|||38907003^Varicella (disorder)^SCT|20220316|F|




Notes

Publicity Code is included in order to support documentation of communication method for the TestCaseGroup:Cohort Report. If the EHR does not support this attribute, the result for this step may indicate pass, but the lack of support should be documented as a notable exception.

The date/time of birth for the twins includes birth time. This aids in distinguishing the birth order for multiple births. Since this patient is not a multiple birth, the vendor can pass with notable exception if the birth date/time does not include precision of birth time. The notable exception should document the lack of support for birth time.

While the PID indicates that it is Vendor Supplied, the ID returned from the registry query is: 123456^^^MYEHR^MR~987633^^^MYIIS^SR. The IIS will not know the PID of the local system, and there is no context-based validation checking for the PID.

Registry status of' 'Active' is required when sending a VXU to the IIS which will be done for this patient.

Manual entry of one of the patient demographics and clinical history will be required (or reviewed) to ensure that entry of the required fields is possible.


1.2.2. Enter Clinical History for Juan Marcel Marina

Test Step Type: SUT_MANUAL
The EHR captures structured data regarding a problem of Chicken Pox (Varicella) as part of the clinical history.

Test Story

Description

The clinical history of varicella (chickenpox) is documented in the record created for Juan Marcel Marina.

The lab tests show serologic immunity to Hep A and a finding is added indicating Hepatitis A Immune.


Comments

No Comments


Pre-condition

The EHR has recorded all of the pediatric demographic in the record created for Juan Marcel Marina.


Post-Condition

The clinical history of the Varicella is documented in the record created for Juan Marcel Marina.

The serologic immunity (Hepatitis A virus IgG+IgM Ab [Presence] in Serum) - result positive and a finding of Hepatitis A Immune is documented in the record for Juan Marcel Marina.


Test Objectives

Supporting data for:

Modify Antigen Recommendations Based on Active Diagnoses: The EHR or other clinical software system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses.

Note: In this case, the vaccine is not recommended due to the history of the vaccine preventable condition (Varicella).


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all clinical history data provided with all required attributes indicated by [Y]. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

Serologic Evidence of Immunity to Hepatitis A is documented in the record:

Lab Result and Finding (01/15/2022):

LOINC 51913-2 Hepatitis A virus IgG+IgM Ab [Presence] in Serum - result positive.

Finding of Hepatitis A Immunity is recorded (SNOMED 278971009 Hepatitis A Immune (finding)).

To minimize data entry, the ADT A04 message provided in Step 1 for this patient: Enter Initial Demographic Data for New Patient Juan Marcel Marina, included this clinical data table and may be used to automate data entry for this step. If this option is used, the proctor will review the ability of the system to record, modify, and store these attributes.


History of Varicella (reason for vaccine forecast to not indicate varicella vaccine due)


Problem (3/16/2022)
Varicella (disorder) SNOMED-CT 38907003); Varicella without complication - (ICD-10-CM B01.9)
Coded Value expected using SNOMED-CT or ICD-10-CM
Y



Notes

Manual entry of one of the patient demographics and clinical history will be required (or reviewed) to ensure that entry of the required fields is possible.


1.3. Juana Mariela Gonzales Initial Data Load

Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for infant twin Juana Mariela Gonzales. There are no transactions associated with this test case.

Test Story

Description

The practice site for the scenario is Shoreline Pediatrics. The EHR vendor loads demographic data and clinical history for twin Juana Mariela Gonzales.


Comments

Set-up step evaluating EHR functions for capturing and storing patient pediatric demographic data, historical immunizations, and clinical conditions. There is no transaction associated with this test step.


Pre-condition

No Pre-Condition


Post-Condition

The EHR has recorded all of the pediatric demographic data, historical immunizations, and clinical conditions in the record created for Juana Mariela Gonzales using the test data provided.


Test Objectives

Register New Patients: The EHR or other clinical software system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. The EHR or other clinical software system must be able to store information to successfully match with patients in immunization registries, if the information is available. Specific to immunization registries, that information includes the mother's maiden name, whether the patient was part of a multiple birth, and the birth order (i.e., ordinal number of birth, first, second, etc.). This information allows the provider to correctly identify the patient and also helps ensure a match when the EHR sends the patient's information to external systems such as an immunization registry.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


1.3.1. Enter Initial Demographic Data for Juana Mariela Gonzales

Test Step Type: SUT_MANUAL
Juana Mariela Gonzales, infant twin, is entered as a new patient in the EHR, including all pediatric demographic information.

Test Story

Description

The EHR vendor loads demographic data for Juana Mariela Gonzales.


Comments

Set-up step evaluating EHR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.


Pre-condition

No Pre-Condition


Post-Condition

The EHR has recorded all of the pediatric demographic data in the record created for Juana Mariela Gonzales.


Test Objectives

Register New Patients: The EHR or other clinical software system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. The EHR or other clinical software system must be able to store information to successfully match with patients in immunization registries, if the information is available. Specific to immunization registries, that information includes the mother's maiden name, whether the patient was part of a multiple birth, and the birth order (i.e., ordinal number of birth, first, second, etc.). This information allows the provider to correctly identify the patient and also helps ensure a match when the EHR sends the patient's information to external systems such as an immunization registry.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

For systems that document vaccine program eligibility at the patient level: not VFC Eligible

To minimize data entry, the ADT A04 message below the data table may be used to automate data entry. If this option is used, the proctor will review the ability of the system to record, modify, and store these attributes.


Patient ID (previously listed as “Medicaid Number”)
Vendor supplied
Y
Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name
Shoreline Pediatrics
Y
Patient ID: Type (e.g., medical record number, IIS ID)
Vendor supplied
Y
Patient Name: First
Juana
Y
Patient Name: Middle
Mariela
Y
Patient Name: Last
Gonzales
Y
Patient Date of Birth
10/01/2022
Y
Birth Time
11am
N
Patient Gender (Administrative Sex)
F
Y
Patient Multiple Birth Indicator
Yes
Y
Patient Birth Order
1
Y
Responsible Person Name: First
Joanna
Y
Responsible Person Name: Middle
Elena
Y
Responsible Person Name: Last
Gonzales
Y
Responsible Person Name: Maiden Last
Morales
N
Relationship to Patient
Mother
Y
Mother’s Name: First
Joanna
Y
Mother’s Name: Middle
Elena
Y
Mother’s Name: Last
Gonzales
Y
Mother’s Name: Maiden Last
Morales
Y
Patient Address: Street
3321 Standish Way
Y
Patient Address: City
Stamford
Y
Patient Address: State
CT
Y
Patient Address: Country
USA
Y
Patient Address: Zipcode
06903
Y
Race
White
Y
Ethnicity
Hispanic or Latino
Y
Patient Primary Language
English
Y
Patient Telephone Number
(203) 555-1214
Y
Patient Telephone Number Type (e.g., home, cell)
Cell
Y
Patient E-mail Address
None
N
Publicity Code
Reminder/recall – no calls (03 HL70215)
Y
Publicity Code Effective Date
10/01/2022
Y
Protection Indicator
N
N
Protection Indicator Effective Date
10/01/2022
N
Immunization Registry Status
active
Y
Preferred Contact Method
Text
Y


ADT A04 Message:

MSH|^~\&|Test EHR Application|X68||NIST Test Iz Reg|20221031082240-0500||ADT^A04^ADT_A01|NIST-IZ-001.00|P|2.5.1|||||||||

PID|1||123456^^^MYEHR^MR~987633^^^MYIIS^SR||Gonzales^Juana^Mariela^^^^L|Morales^Joanna^Elena^^^^M|202210011100|F||2106-3^White^CDCREC|3321 Standish Way^Stamford^CT^06903^USA^L||^PRN^CP^^1^203^5551214||eng^English^ISO639|||||||2135-2^Hispanic or Latino^CDCREC||Y|1

PD1|||||||||||03^Reminder/recall – no calls^HL70215|N|20221001|||A|20221001|20221001

NK1|1|Gonzales^Joanna^Elena^^^^L|MTH^Mother^HL70063|3321 Standish Way^^Stamford^CT^06903^^L|^PRN^CP^^1^203^5551214

PV1||O|||||^Smith^Frank^^^^^^^L^^^^^^^^^^^MD|^Smith^Frank^^^^^^^L^^^^^^^^^^^MD|||||||||||||||||||||||||||||||SP^Shoreline Pediatrics^HL70362||||||



Notes

Publicity Code is included in order to support documentation of communication method for the TestCaseGroup:Cohort Report. If the EHR does not support this attribute, the result for this step may indicate pass, but the lack of support should be documented as a notable exception.

The date/time of birth for the twins includes birth time. This aids in distinguishing the birth order of the twins, but as long as birth order is supplied, the vendor can pass with notable exception if the birth date/time does not include precision of birth time. The notable exception should document the lack of support for birth time.

While the PID indicates that it is Vendor Supplied, the ID returned from the registry query is: 123456^^^MYEHR^MR~987633^^^MYIIS^SR. The IIS will not know the PID of the local system, and there is no context-based validation checking for the PID.

Protection Indicator Effective Date may use current date if constrained by EHR workflow.

Registry status of' 'Active' is required when sending a VXU to the IIS which will be done for this patient.

Manual entry of one of the patient demographics and clinical history will be required (or reviewed) to ensure that entry of the required fields is possible.


1.4. Juana Maria Gonzales Initial Data Load

Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for infant twin Juana Maria Gonzales. There are no transactions associated with this test case.

Test Story

Description

The practice site for the scenario is Shoreline Pediatrics. The EHR vendor loads demographic data and clinical history for twin Juana Maria Gonzales.


Comments

Set-up step evaluating EHR functions for capturing and storing patient pediatric demographic data, historical immunizations, and clinical conditions. There is no transaction associated with this test step.


Pre-condition

No Pre-Condition


Post-Condition

The EHR has recorded all of the pediatric demographic data, historical immunizations, and clinical conditions in the record created for Juana Maria Gonzales using the test data provided.


Test Objectives

Register New Patients: The EHR or other clinical software system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. The EHR or other clinical software system must be able to store information to successfully match with patients in immunization registries, if the information is available. Specific to immunization registries, that information includes the mother's maiden name, whether the patient was part of a multiple birth, and the birth order (i.e., ordinal number of birth, first, second, etc.). This information allows the provider to correctly identify the patient and also helps ensure a match when the EHR sends the patient's information to external systems such as an immunization registry.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


1.4.1. Enter Initial Demographic Data for Juana Maria Gonzales

Test Step Type: SUT_MANUAL
Juana Maria Gonzales, infant twin, is entered as a new patient in the EHR, including all pediatric demographic information.

Test Story

Description

The EHR vendor loads demographic data for Juana Maria Gonzales.


Comments

Set-up step evaluating EHR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.


Pre-condition

No Pre-Condition


Post-Condition

The EHR has recorded all of the pediatric demographic data in the record created for Juana Maria Gonzales.


Test Objectives

Register New Patients: The EHR or other clinical software system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. The EHR or other clinical software system must be able to store information to successfully match with patients in immunization registries, if the information is available. Specific to immunization registries, that information includes the mother's maiden name, whether the patient was part of a multiple birth, and the birth order (i.e., ordinal number of birth, first, second, etc.). This information allows the provider to correctly identify the patient and also helps ensure a match when the EHR sends the patient's information to external systems such as an immunization registry.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

For systems that document vaccine program eligibility at the patient level: Not VFC Eligible

To minimize data entry, the ADT A04 message below the data table may be used to automate data entry. If this option is used, the proctor will review the ability of the system to record, modify, and store these attributes.


Patient ID (previously listed as “Medicaid Number”)
Vendor supplied
Y
Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name
Shoreline Pediatrics
Y
Patient ID: Type (e.g., medical record number, IIS ID)
Vendor supplied
Y
Patient Name: First
Juana
Y
Patient Name: Middle
Maria


Y
Patient Name: Last
Gonzales


Y
Patient Date of Birth
10/01/2022
Y
Birth Time
11:15am
N
Patient Gender (Administrative Sex)
F
Y
Patient Multiple Birth Indicator
Yes
Y
Patient Birth Order
2
Y
Responsible Person Name: First
Joanna
Y
Responsible Person Name: Middle
Elena
Y
Responsible Person Name: Last
Gonzales
Y
Responsible Person Name: Relationship to Patient
Mother
Y
Mother’s Name: First
Joanna
Y
Mother’s Name: Middle
Elena
Y
Mother’s Name: Last
Gonzales
Y
Mother’s Name: Maiden Last
Morales
Y
Patient Address: Street
3321 Standish Way
Y
Patient Address: City
Stamford
Y
Patient Address: State
CT
Y
Patient Address: Country
USA
Y
Patient Address: Zipcode
06903
Y
Race
White
Y
Ethnicity
Hispanic or Latino
Y
Patient Primary Language
English
Y
Patient Telephone Number
(203) 555-1214
Y
Patient Telephone Number Type (e.g., home, cell)
Cell
Y
Patient E-mail Address
None
N
Publicity Code
Reminder/recall – no calls (03 HL70215)
Y


Publicity Code Effective Date
10/01/2022
Y
Protection Indicator
Y
Y


Protection Indicator Effective Date
10/01/2022
Y
Immunization Registry Status
Active
Y
Preferred Contact Method
Text
Y


ADT A04 Message:

MSH|^~\&|Test EHR Application|X68||NIST Test Iz Reg|20221031082240-0500||ADT^A04^ADT_A01|NIST-IZ-001.00|P|2.5.1|||||||||

PID|1||123456^^^MYEHR^MR~987633^^^MYIIS^SR||Gonzales^Juana^Maria^^^^L|Morales^Joanna^Elena^^^^M|202210011115|F||2106-3^White^CDCREC|3321 Standish Way^^Stamford^CT^06903^USA^L||^PRN^CP^^1^203^5551214||eng^English^ISO639|||||||2135-2^Hispanic or Latino^CDCREC||Y|2

PD1|||||||||||03^Reminder/recall – no calls^HL70215|Y|20221001|||A|20221001|20221001

NK1|1|Gonzales^Joanna^Elena^^^^L|MTH^Mother^HL70063|3321 Standish Way^^Stamford^CT^06903^^L|^PRN^CP^^1^203^5551214

PV1||O|||||^Smith^Frank^^^^^^^L^^^^^^^^^^^MD|^Smith^Frank^^^^^^^L^^^^^^^^^^^MD|||||||||||||||||||||||||||||||SP^Shoreline Pediatrics^HL70362||||||



Notes

Publicity Code is included in order to support documentation of communication method for the TestCaseGroup:Cohort Report. If the EHR does not support this attribute, the result for this step may indicate pass, but the lack of support should be documented as a notable exception.

The date/time of birth for the twins includes birth time. This aids in distinguishing the birth order of the twins, but as long as birth order is supplied, the vendor can pass with notable exception if the birth date/time does not include precision of birth time. The notable exception should document the lack of support for birth time.

While the PID indicates that it is Vendor Supplied, the ID returned from the registry query is: 123456^^^MYEHR^MR~987633^^^MYIIS^SR. The IIS will not know the PID of the local system, and there is no context-based validation checking for the PID.

Protection Indicator Effective Date may use current date if constrained by EHR workflow.

Registry status of' 'Active' is required when sending a VXU to the IIS which will be done for this patient.

Manual entry of one of the patient demographics and clinical history will be required (or reviewed) to ensure that entry of the required fields is possible.


1.5. Anita Francesca Marina Initial Data Load

Demonstrates the ability to record adult demographic data, historical vaccinations, and clinical conditions for adult Anita Francesca Marina. There are no transactions associated with this test case.

Test Story

Description

The practice site for the scenario is Metro Primary Care. The EHR vendor loads demographic data and clinical history for Adult Anita Francesca Marina.


Comments

Set-up step evaluating EHR functions for capturing and storing patient adult demographic data, historical immunizations, and clinical conditions. There is no transaction associated with this test step.


Pre-condition

No Pre-Condition


Post-Condition

The EHR has recorded all of the adult demographic data, historical immunizations, and clinical conditions in the record created for Anita Francesca Marina using the test data provided.


Test Objectives

Register New Patients: The EHR or other clinical software system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. The EHR or other clinical software system must be able to store information to successfully match with patients in immunization registries, if the information is available. Specific to immunization registries, that information includes the mother's maiden name, whether the patient was part of a multiple birth, and the birth order (i.e., ordinal number of birth, first, second, etc.). This information allows the provider to correctly identify the patient and also helps ensure a match when the EHR sends the patient's information to external systems such as an immunization registry.

Provide Access to Update Immunization Information: The patient is able to add or request an update to immunization information for review by the provider.

Review Patient-Provided Immunization Information: The EHR or other clinical software system provides a mechanism for the provider to review patient-generated immunization data. It also provides a mechanism for the provider to update or annotate the immunization history, indicating the source of the information.

Request/Receive Patient Immunization Data and Identify Source: The EHR stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.

Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

   Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

  - 2002 : Indicates that the date of birth messaged in PID-7 is after the date of death messaged in PID-29.

  - 2100  : Indicates that any date field is in the future. Specific errors for date transmitted in an OBX are also provided.

  - 2202 : Indicates individual components of the address are valid, but overall, the address is invalid (conflict between elements, non-existent address, etc)

  - 2007: Indicates a conflict between PID-29 and PID-30 or between PD1-16 and either PID field. In other words, one element indicates the patient is deceased and another element indicates the patient is not deceased.

  - 2306 : Indicates that the patient found is too old.


Supporting data for:

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient (Return Evaluated Immunization History and Forecast (Z42) – HL7 Version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5). The EHR is able to display the evaluated immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if they choose to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


1.5.1. Demographic Data Quality Checks for Anita Francesca Marina

Test Step Type: SUT_MANUAL
The provider attempts to add Anita Francesca Marina as a new adult patient in the EHR. Demographic data quality checks are verified during data entry.

Test Story

Description

The EHR vendor attempts to enter demographic data for new adult patient Anita Francesca Marina. These data quality checks primarily relate to improving patient matching information that will be included when submitting data to the immunization registry or when querying the immunization registry.


Comments

Evaluates EHR functions for verifying data quality of demographic data used for patient matching. There is no transaction associated with this test step.


Pre-condition

No Pre-Condition


Post-Condition

The EHR has alerted the provider for each of the data quality checks verified for Anita Francesca Marina.


Test Objectives

Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

  - 2002 : Indicates that the date of birth messaged in PID-7 is after the date of death messaged in PID-29.

  -  2100  : Indicates that any date field is in the future. Specific errors for date transmitted in an OBX are also provided.

  - 2202 : Indicates individual components of the address are valid, but overall, the address is invalid (conflict between elements, non-existent address, etc)

  - 2007: Indicates a conflict between PID-29 and PID-30 or between PD1-16 and either PID field. In other words, one element indicates the patient is deceased and another element indicates the patient is not deceased.

  - 2306 : Indicates that the patient found is too old.


Evaluation Criteria

Evaluation Criteria: During the course of data entry for information below, the EHR triggers the following data quality issues:

  1. Triggers Error that patient is too old (2306)
  2. Triggers error indicating, conflict: one element indicates the patient is deceased and another element indicates the patient is not deceased. (2207)
  3. Triggers Error that the birth date is after the death date (2002)
  4. Triggers conflict in address (Zip inconsistent with city and state) (2202)
Patient ID (previously listed as “Medicaid Number”)
Vendor supplied
N
Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name
Metro Primary Care
N
Patient ID: Type (e.g., medical record number, IIS ID)
Vendor supplied
N
Patient Name: First
Anita
N
Patient Name: Middle
Francesca
N
Patient Name: Last
Marina
N
Patient Date of Birth
06/01/1887
Y – Triggers Error that patient is too old (2306)
Corrected Date of Birth
06/01/1997
Y
Death Indicator
Not Deceased
Y – Triggers error indicating, conflict: one element indicates the patient is deceased and another element indicates the patient is not deceased.
(2207)
Patient Death Date
12/01/1992
Y – Triggers Error that the birth date is after the death date (2002)
Birth Time
N/A
N
Patient Gender (Administrative Sex)
F
N
Patient Multiple Birth Indicator
No
N
Patient Birth Order
N/AN
Responsible Person Name: First
Anita
N
Responsible Person Name: Middle
Francesca
N
Responsible Person Name: Last
Marina
N
Responsible Person Name: Maiden Last
N/A
N
Responsible Person Name: Relationship to Patient
Self
N
Mother’s Name: First
Sophia
N
Mother’s Name: Middle
Serena
N
Mother’s Name: Last
Santos
N
Mother’s Name: Maiden Last
Ramirez
N
Patient Address: Street
4623 Standish Way
N
Patient Address: City
Stamford
Y – Triggers conflict in address with ZIP (2202)
Patient Address: State
CT
Y – Triggers conflict in address with ZIP (2202)
Patient Address: Country
USA
N
Patient Address: Zipcode
96903
Y – Triggers conflict in address with City and State (2202)
Race
White
N
Ethnicity
Hispanic or Latino
N
Patient Primary Language
English
N
Patient Telephone Number
(203) 555-1215
N
Patient Telephone Number Type (e.g., home, cell)
Cell
N
Patient E-mail Address
Proctor Supplied
N
Publicity Code
Reminder/recall – any method (02 HL70215)
N
Publicity Code Effective Date
10/01/2013
Y
Protection Indicator
N
Y
Protection Indicator Effective Date
06/1/2027
Y – Triggers error that date is in the future (2100)
Immunization Registry Status
Active
Y
Preferred Contact Method
Email
N



Notes

The full demographic details are provided here to facilitate the documentation constraints and/or screens that may be required by the vendor in order to attempt to document the data of interest, but these are not verified until the next step. 

The Anita Francesca email supplied should be provided by the test proctor so they can receive the patient notifications. For the purpose of internal Vendor testing they can use their own emails.

Registry status of' 'Active' is required when sending a VXU to the IIS which will be done for this patient.

Manual entry of one of the patient demographics and clinical history will be required (or reviewed) to ensure that entry of the required fields is possible.


1.5.2. Enter Initial Demographic Data for Anita Francesca Marina

Test Step Type: SUT_MANUAL
Anita Francesca Marina, adult, is entered as a new patient in the EHR, including all adult demographic information. Clinical and Social History data supporting immunization related recommendations are also documented.

Test Story

Description

The EHR vendor loads demographic and social history data for Anita Francesca Marina.


Comments

Set-up step evaluating EHR functions for capturing and storing adult demographic data and social history data supporting immunization recommendations. There is no transaction associated with this test step.


Pre-condition

No Pre-Condition


Post-Condition

The EHR has recorded all of demographic and social history data in the record created for Anita Francesca Marina.


Test Objectives

Register New Patients: The EHR or other clinical software system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. The EHR or other clinical software system must be able to store information to successfully match with patients in immunization registries, if the information is available. Specific to immunization registries, that information includes the mother's maiden name, whether the patient was part of a multiple birth, and the birth order (i.e., ordinal number of birth, first, second, etc.). This information allows the provider to correctly identify the patient and also helps ensure a match when the EHR sends the patient's information to external systems such as an immunization registry.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, with all required attributes indicated by [Y]. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

To minimize data entry, the ADT A04 message below the data table may be used to automate data entry. If this option is used, the proctor will review the ability of the system to record, modify, and store these attributes. This ADT message includes clinical content referenced in step 5.


Patient ID (previously listed as “Medicaid Number”)
Vendor supplied
Y
Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name
Metro Primary Care
Y
Patient ID: Type (e.g., medical record number, IIS ID)
Vendor supplied
Y
Patient Name: First
Anita
Y
Patient Name: Middle
Francesca


Y
Patient Name: Last
Marina


Y
Patient Date of Birth
06/01/1997
Y
Birth Time
N/A
N
Patient Gender (Administrative Sex)
F
Y
Patient Multiple Birth Indicator
N
Y
Patient Birth Order
N/A
Y
Responsible Person Name: First
Anita
Y
Responsible Person Name: Middle
Francesca
Y
Responsible Person Name: Last
Marina
Y
Responsible Person Name: Maiden Last
N/A
N
Responsible Person Name: Relationship to Patient
Self
Y
Mother’s Name: First
Sophia
Y
Mother’s Name: Middle
Serena
Y
Mother’s Name: Last
Santos
Y
Mother’s Name: Maiden Last
Ramirez
Y
Patient Address: Street
4623 Standish Way
Y
Patient Address: City
Stamford
Y
Patient Address: State
CT
Y
Patient Address: Country
USA
Y
Patient Address: Zipcode
06903
Y
Race
White
Y
Ethnicity
Hispanic or Latino
Y
Patient Primary Language
English
Y
Patient Telephone Number
(203) 555-1213
Y
Patient Telephone Number Type (e.g., home, cell)
Cell
Y
Patient E-mail Address
Proctor Supplied
Y
Publicity Code
Reminder/recall – any method (02 HL70215)
Y


Publicity Code Effective Date
10/01/2013
Y
Protection Indicator
N
Y


Protection Indicator Effective Date
10/1/2013
Y
Immunization Registry Status
Active
Y
Preferred Contact Method
Email
Y


   Social History:


Occupation
Adult Health Clinical Nurse Specialist [Clinical Nurse Specialists]
C
Industry
Home nursing services (except private practices) [Home Health Care Services]
C
Employer
River Rehabilitation Center
C


ADT A04 Message:

MSH|^~\&|Test EHR Application|X68||NIST Test Iz Reg|20221031082240-0500|ADT^A04^ADT_A01|NIST-IZ-001.00|P|2.5.1|||||||||

PID|1||123456^^^MYEHR^MR~987633^^^MYIIS^SR||Marina^Anita^Francesca^^^^L|Santos^Sophia^Serena^^^^M|19970601|F||2106-3^White^CDCREC|4623 Standish Way^^Stamford^CT^06903^USA^L||^PRN^CP^^1^203^5551213||eng^English^ISO639|||||||2135-2^Hispanic or Latino^CDCREC||N

PD1|||||||||||02^Reminder/Recall – any method^HL70215|N|20131001|||A|20131001|20131001

NK1|1||EMR^Employer^HL70063^^^^2.5.1|15 State St^^Stamford^CT^06903^^L|||||||||River Rehabilitation Center^L|||||||||||||||||

PV1||O|||||^Jobs^John^^^^^^^L^^^^^^^^^^^MD|^Jobs^John^^^^^^^L^^^^^^^^^^^MD|||||||||||||||||||||||||||||||MPC^Metro Primary Care^HL70362||||||

OBX|1|CE|51913-2^Hepatitis A virus IgG+IgM Ab [Presence] in Serum^LN|1|260373001^Detected^SCT||||||F|||20180515

OBX|2|CE|51914-0^Hepatitis B virus core IgG+IgM Ab [Presence] in Serum^LN|1|260415000^Not Detected^SCT||||||F|||20180515

OBX|3|CWE|21844-6^Usual Industry^LN||621610.008495^Home nursing services (except private practices)^ODH||||||F|||20221031|||||||||||||||

OBX|4|CWE|21843-8^History of Usual Occupation^LN||29-1141.04.000450^Adult Health Clinical Nurse Specialist^ODH||||||F|||20221031|||||||||||||||

DG1|1|||278971009^Hepatitis A immune (finding)^SCT|20180515|F|

DG1|2|||165808001^Hepatitis B non-immune (finding)^SCT|20180515|F|




Notes

Publicity Code is included in order to support documentation of communication method for the TestCase: Notify Patients of Immunization Status. If the EHR does not support this attribute, the result for this step may indicate pass, but the lack of support should be documented as a notable exception.

While the PID indicates that it is Vendor Supplied, the ID returned from the registry query is: 123456^^^MYEHR^MR~987633^^^MYIIS^SR. The IIS will not know the PID of the local system, and there is no context-based validation checking for the PID.

Protection Indicator Effective Date may use current date if constrained by EHR workflow.

Document in notable exceptions where any of the social history attributes can not be captured/recorded by product.

The Anita Francesca email supplied should be provided by the test proctor so they can receive the patient notifications. For the purpose of internal Vendor testing they can use their own emails.

Manual entry of one of the patient demographics and clinical history will be required (or reviewed) to ensure that entry of the required fields is possible.


1.5.3. Anita Francesca Marina Electronically Submits Prior Immunization to Provider

Test Step Type: SUT_MANUAL
The patient communicates to her Primary Care Provider that she received her annual influenza vaccine through her employer in another state, and she provided the information for her PCP to review through patient facing features (e.g. portal) offered by the EHR.

Test Story

Description

The patient is able to provide information about the influenza vaccine that she received through her employer out of state using the patient facing features (e.g. portal) offered by the EHR.


Comments

No Comments


Pre-condition

The patient has been provided access to a patient facing mechanism to provide information electronically to the provider regarding her historical immunization record.


Post-Condition

The immunization history from the employer as reported by the patient is available for review by the provider through the EHR.


Test Objectives

Provide Access to Update Immunization Information: The patient is able to add or request an update to immunization information for review by the provider.


Evaluation Criteria

Evaluation Criteria: Vendor successfully captures the historical vaccination information from the patient. The electronic information provided may be supplied by whatever means is offered through the EHR (e.g. email, uploaded pdf, patient entered into a form, etc.).

The information provided by the patient for review by the physician includes:

Historical Vaccine from Employer Reported by Patient – Influenza


Entered By
Anita Francesca Marina
Y
Ordering Provider
John Jobs
N
Entering Organization
N/A
N
Vaccine Event information source (Administration Notes)
Historical information – from other provider (NIP001 02)
Y
Date/Time of Start of Administration
09/01/2022
Y
Vaccine Administered
influenza, recombinant, quadrivalent, injectable, preservative free (CVX 185) Flublok Quadrivalent Northern Hemisphere (NDC 49281-0722-88)
Y
Administered Amount (of Vaccine)
0.5
Y
Administered Units (of Measure)
mL
Y
Administering Provider
Sophia Muir
N
Administered-at Location
River Rehabilitation Center, 15 River Road, Port Chester New York 10573
Y
Lot Number
8L4B3423
Y
Substance Expiration Date
12/31/2022
Y
Substance Manufacturer Name
Sanofi Pasteur Inc. (MVX PMC)
Y
Route of Administration
Intramuscular (NCIT: C28161, HL70162: IM)
Y
Administration Site
Right Deltoid (HL7 HL70163: RD)
Y
Completion Status
Completed (CP)
Y

Notes

The EHR may collect the information from the patient through any electronic means. The tester shall document the method used to capture the information.

The patient provided information is not part of the EHR until the provider reviews the information in the next step and accepts/modifies the content.


1.5.4. Provider Review and Entry of Immunization Data for Anita Francesca Marina Provided by Patient

Test Step Type: SUT_MANUAL
The provider is able to review the patient provided vaccine information for the annual influenza vaccine through her employer in another state. The provider is able to document this historical vaccine in the EHR.

Test Story

Description

The provider is able to review the patient provided vaccine information for the influenza vaccine that she received through her employer out of state. The provider is able to document this historical vaccine in the EHR.


Comments

No Comments


Pre-condition

The patient has been provided access to the patient immunization history record.

The immunization administered through Anita Francesca Marina’s employer, and as reported by the patient is available for review by the provider through the EHR.


Post-Condition

The immunization history from patient-provided vaccine history has been reviewed by the provider and is loaded into the record created for Anita Francesca Marina.


Test Objectives

Review Patient-Provided Immunization Information: The EHR or other clinical software system provides a mechanism for the provider to review patient-generated immunization data.  It also provides a mechanism for the provider to update or annotate the immunization history, indicating the source of the information.

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Request/Receive Patient Immunization Data and Identify Source: The EHR stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.

 

Supporting data for:

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient (Return Evaluated Immunization History and Forecast (Z42) – HL7 Version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5). The EHR is able to display the evaluated immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if they choose to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.


Evaluation Criteria

Evaluation Criteria: Vendor successfully captures the historical vaccination information from the patient that she received through her employer. The electronic information provided may be supplied by whatever means is offered through the EHR (e.g. email, uploaded pdf, patient entered into a form, etc.).

The information provided by the patient for review and recording by the physician includes:

Historical Vaccine from Employer Reported by Patient – Influenza


Entered By
Jessica Mason
Y
Ordering Provider
John Jobs
N
Entering Organization
Metro Primary Care
Y
Vaccine Event information source (Administration Notes)
Historical information – from other provider (NIP001 02)
Y
Date/Time of Start of Administration
09/01/2022
Y
Vaccine Administered
influenza, recombinant, quadrivalent, injectable, preservative free (CVX 185) Flublok Quadrivalent Northern Hemisphere (NDC 49281-0722-88)
Y
Administered Amount (of Vaccine)
0.5
Y
Administered Units (of Measure)
mL
Y
Administering Provider
Sophia Muir
N
Administered-at Location
River Rehabilitation Center, 15 River Road, Port Chester New York 10573
Y
Lot Number
8L4B3423
Y
Substance Expiration Date
12/31/2022
Y
Substance Manufacturer Name
Sanofi Pasteur Inc. (MVX PMC)
Y
Route of Administration
Intramuscular (NCIT: C28161, HL70162: IM)
Y
Administration Site
Right Deltoid (HL7 HL70163: RD)
Y
Completion Status
Completed (CP)
Y

Notes

The EHR may collect the information from the patient through any electronic means. The tester shall document the method used to inform the provider of the historical vaccine information and to allow for the provider review.


1.5.5. Enter Clinical History for Anita Francesca Marina

Test Step Type: SUT_MANUAL
The EHR documents structured laboratory tests showing serologic immunity to Hepatitis A, and no serologic immunity to Hepatitis B as part of the clinical history.

Test Story

Description

Lab tests show serologic immunity to Hepatitis A, and no serologic immunity to Hepatitis B. These finding are in the documented in the record created for Anita Francesca Marina indicating that she is Hepatitis A Immune, and that she has no immunity to Hepatitis B.


Comments

No Comments


Pre-condition

The EHR has recorded the demographic information in the record created for Anita Francesca Marina.


Post-Condition

The serologic immunity (Hepatitis A virus IgG+IgM Ab [Presence] in Serum) - result positive and a finding of Hepatitis A Immune is documented in the record for Anita Francesca Marina.

The lack of serologic immunity (Hepatitis B virus IgG+IgM Ab [Presence] in Serum) - result negative and a finding of Hepatitis B non-immunity is documented in the record for Anita Francesca Marina.


Test Objectives

Support for:

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations.

 Note: clinical history for adult healthcare worker supporting vaccine recommendations.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all clinical history data provided. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

Serologic Evidence of Non-Immunity to Hepatitis B and Serologic evidence of Immunity to Hepatitis A are documented in the record:

Lab Result and Finding (05/15/2018):

LOINC 51913-2 Hepatitis A virus IgG+IgM Ab [Presence] in Serum – result positive

LOINC 51914-0 Hepatitis B virus core IgG+IgM Ab [Presence] in Serum - result negative

Finding of Hepatitis A Immunity is recorded (SNOMED 278971009 Hepatitis A immune (finding))

Finding of Hepatitis B non-immunity is recorded (SNOMED 165808001 Hepatitis B non-immune (finding))


Notes

Manual entry of one of the patient demographics and clinical history will be required (or reviewed) to ensure that entry of the required fields is possible.



1.6. Enter Inventory

Demonstrates the ability to enter and update inventory with stock received.

Test Story

Description

The provider enters vaccine inventory data from available inventory.


Comments

2D barcodes are provided as an option to enter the inventory.


Pre-condition

No Pre-Condition


Post-Condition

Vaccine inventory is recorded and available in the EHR.


Test Objectives

Update Vaccine Inventory from Stock Receipt: The EHR or other clinical software system updates the vaccine inventory when new stock is received at the site and updates the correct count of each vaccine, including those for use in guarantee programs (such as Vaccines for Children) and for private stock.

Display Available Vaccine Antigens: The system presents a list of vaccine antigens available for administration to patients (i.e., private stock vs. specific guarantee program).


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

Vendors are encouraged to scan the 2D barcode images as data input. If vendors use a 2D barcode scanner it is expected that at least one vaccine product into the system’s inventory. Tester should document feedback and any identified issues with 2D barcode images.


1.6.1. Enter Vaccine Inventory

Test Step Type: SUT_MANUAL
Demonstrates the ability to enter and update inventory with stock received.

Test Story

Description

The provider receives a vaccine delivery and records the new vaccine data in available inventory.


Comments

Set-up step evaluating EHR functions for capturing and storing vaccine inventory data.


Pre-condition

No Pre-Condition


Post-Condition

Vaccine inventory is recorded and available in the EHR.


Test Objectives

Update Vaccine Inventory from Stock Receipt: The EHR or other clinical software system updates the vaccine inventory when new stock is received at the site and updates the correct count of each vaccine, including those for use in guarantee programs (such as Vaccines for Children) and for private stock.


Evaluation Criteria

Vendor successfully records all vaccine inventory data provided:

Item 1


Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0890-41
Product Name:
FLUARIX QUADRIVALENT
Lot#:
8L4B3521
Expiration Date:
12/31/2023
GTIN:
10358160890410
Vaccine source:
VFC
Quantity:
12
Presentation:
Prefilled syringe (PFS)
2D Barcode:


Item 2


Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0890-41
Product Name:
FLUARIX QUADRIVALENT
Lot#:
D8043IN8422
Expiration Date:
12/31/2023
GTIN:
10358160890410
Vaccine source:
VFC
Quantity:
15
Presentation:
Prefilled syringe (PFS)
2D Barcode:


Item 3


Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0890-41
Product Name:
FLUARIX QUADRIVALENT
Lot#:
D8043IN8855
Expiration Date:
12/31/2023
GTIN:
10358160890410
Vaccine source:
VFC
Quantity:
12
Presentation:
Prefilled syringe (PFS)
2D Barcode:


Item 4


Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0820-43
Product Name:
ENGERIX-B
Lot#:
6332FK18
Expiration Date:
06/15/2022
GTIN:
10358160820431
Vaccine source:
Non-VFC
Quantity:
18
Presentation:
Prefilled syringe (PFS)
2D Barcode:


Item 5


Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0820-43
Product Name:
ENGERIX-B
Lot#:
6332FK26
Expiration Date:
12/31/2023
GTIN:
10358160820431
Vaccine source:
Non-VFC
Quantity:
20
Presentation:
Prefilled syringe (PFS)
2D Barcode:


Item 6


Use (Vial or Syringe)
Labeler:

NDC:
58160-0811-43
Product Name:
Pediarix
Lot#:
6559FK32
Expiration Date:
12/31/2023
GTIN:
10358160811439
Vaccine source:
Non-VFC
Quantity:
16
Presentation:
Prefilled syringe (PFS)
2D Barcode:


Item 7


Use (Vial or Syringe)
Labeler:
Pfizer Manufacturing Belgium NV
NDC:
59267-1000-01
Product Name:
Pfizer-BioNTech Covid-19 Vaccine
Lot#:
8L7B3418
Expiration Date
12/31/2023
GTIN:
00359267100016 (see notes)
Vaccine source:
Non-VFC
Quantity (doses):
450
Presentation:
Multi-use vials
2D Barcode:
See Notes


Item 8


Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0821-05
Product Name:
ENGERIX-B (adult)
Lot#:
6942FL12
Expiration Date:
12/31/2023
GTIN:
10358160821056
Vaccine source:
Non-VFC
Quantity:
16
Presentation:
Prefilled syringe (PFS)
2D Barcode:

Notes

Vendors are encouraged to scan the 2D Barcode images as data input. Tester should document feedback and any identified issues with 2D Barcode images. 

A GTIN for Pfizer-BioNTech COVID-19 Vaccine (PURPLE CAP) (NDC: NDC 59267-1000-01) had not yet been assigned at the time this test plan was generated. A GTIN was generated for the purpose of this test according to GS1 standards and may be updated in the future should this be changed in IIS: NDC Lookup Crosswalk published by CDC. The lack of an assigned GTIN also means a GS1 DataMatrix (2D barcode) was not created for this test plan. Vendors must therefore hand enter this vaccine information.

Because the influenza season may not align with the test plan execution, the most current influenza vaccine may not be present.

The new vaccine information needs to be added before inventory can be added for a specific vaccine.


1.6.2. View Inventory

Test Step Type: SUT_MANUAL
Demonstrates the ability to enter and update inventory with stock received.

Test Story

Description

The provider reviews the full list of vaccine inventory.


Comments

No Comments


Pre-condition

Inventory has been entered into the EHR.


Post-Condition

The list of available inventory is displayed.


Test Objectives

Display Available Vaccine Antigens: The system presents a list of vaccine antigens available for administration to patients (i.e., private stock vs. specific guarantee program).


Evaluation Criteria

The EHR inventory shows (minimally):

Item 1


Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0890-41
Product Name:
FLUARIX QUADRIVALENT
Lot#:
8L4B3521
Expiration Date:
12/31/2023
GTIN:
10358160890410
Vaccine source:
VFC
Quantity:
12
Presentation:
Prefilled syringe (PFS)
2D Barcode:


Item 2


Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0890-41
Product Name:
FLUARIX QUADRIVALENT
Lot#:
D8043IN8422
Expiration Date:
12/31/2023
GTIN:
10358160890410
Vaccine source:
VFC
Quantity:
15
Presentation:
Prefilled syringe (PFS)
2D Barcode:


Item 3


Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0890-41
Product Name:
FLUARIX QUADRIVALENT
Lot#:
D8043IN8855
Expiration Date:
12/31/2023
GTIN:
10358160890410
Vaccine source:
VFC
Quantity:
12
Presentation:
Prefilled syringe (PFS)
2D Barcode:


Item 4


Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0820-43
Product Name:
ENGERIX-B
Lot#:
6332FK18
Expiration Date:
06/15/2022
GTIN:
10358160820431
Vaccine source:
Non-VFC
Quantity:
18
Presentation:
Prefilled syringe (PFS)
2D Barcode:


Item 5


Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0820-43
Product Name:
ENGERIX-B
Lot#:
6332FK26
Expiration Date:
12/31/2023
GTIN:
10358160820431
Vaccine source:
Non-VFC
Quantity:
20
Presentation:
Prefilled syringe (PFS)
2D Barcode:


Item 6


Use (Vial or Syringe)
Labeler:

NDC:
58160-0811-43
Product Name:
Pediarix
Lot#:
6559FK32
Expiration Date:
12/31/2023
GTIN:
10358160811439
Vaccine source:
Non-VFC
Quantity:
16
Presentation:
Prefilled syringe (PFS)
2D Barcode:


Item 7


Use (Vial or Syringe)
Labeler:
Pfizer Manufacturing Belgium NV
NDC:
59267-1000-01
Product Name:
Pfizer-BioNTech Covid-19 Vaccine
Lot#:
8L7B3418
Expiration Date
12/31/2023
GTIN:
00359267100016 (See Notes)
Vaccine source:
Non-VFC
Quantity (doses):
450
Presentation:
Multi-use vials
2D Barcode:
See Notes


Item 8


Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0821-05
Product Name:
ENGERIX-B (adult)
Lot#:
6942FL12
Expiration Date:
12/31/2023
GTIN:
10358160821056
Vaccine source:
Non-VFC
Quantity:
16
Presentation:
Prefilled syringe (PFS)
2D Barcode:

Notes

Tester should document how quantity is displayed and what is present (e.g. volume, # doses).

Because the influenza season may not align with the test plan execution, the most current influenza vaccine may not be present.

A GTIN for Pfizer-BioNTech COVID-19 Vaccine (PURPLE CAP) (NDC: NDC 59267-1000-01) had not yet been assigned at the time this test plan was generated. A GTIN was generated for the purpose of this test according to GS1 standards and may be updated in the future should this be changed in IIS: NDC Lookup Crosswalk published by CDC. The lack of an assigned GTIN also means a GS1 DataMatrix (2D barcode) was not created for this test plan. Vendors must therefore hand enter this vaccine information.


1.7. Manage Configuration

Demonstrates the ability to modify the configuration with new information (e.g. New Vaccine codes, new VIS document information, etc), the ability to modify vaccine recommendations, and the ability to configure and use the SOAP-based CDC WSDL for Transport.

Test Story

Description

The user responsible for the EHR configuration updates the system with new vaccine codes, new vaccine schedules, and establishes SOAP-bases CDC WSDL configuration.


Comments

No Comments


Pre-condition

The EHR configuration needs updating.


Post-Condition

The codes for the new vaccine are available in the EHR to document the administration of a new vaccine product. The vaccine recommendation is updated for this new vaccine, and the EHR is configured to use the SOAP-based CDC WSDL for communications with an IIS.


Test Objectives

Add new vaccine codes:  Add codes to support new vaccines. This includes vaccine codes (CVX), National Drug Codes (NDC), and Vaccine Information Statement codes (VIS).

Update Patient Immunization Schedule: The EHR or other clinical software system displays a patient’s anticipated immunization schedule routinely and updates the patient’s schedule when immunization guidelines change.

Configure SOAP-based CDC WSDL for Transport: The EHR or other clinical software system configures connectivity using the SOAP-based CDC WSDL and demonstrates compliance with this standard transport

Add Jurisdiction-Specific Vaccine Eligibility Code: The EHR or other clinical software system demonstrates the ability to configure dose level vaccine eligibility codes per jurisdictional requirements. This includes tracking and exchanging a jurisdiction-specific dose level eligibility code for administered vaccines. Note that this capability only applies to newly administered doses, not historical doses.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

None


1.7.1. Add New Vaccine Information

Test Step Type: SUT_MANUAL
Demonstrates the ability to modify the configuration with new information (e.g. New Vaccine codes, new VIS document information, etc).

Test Story

Description

The user responsible for the EHR configuration updates the system with new CVX, NDC, and VIS vaccine codes.


Comments

No Comments


Pre-condition

The EHR configuration needs updating with new vaccine information.


Post-Condition

The CVX, NDC, and VIS codes for the new vaccine is available in the EHR to document the administration of this new product.


Test Objectives

Add new vaccine codes: Add codes to support new vaccines. This includes vaccine codes (CVX), National Drug Codes (NDC), and Vaccine Information Statement codes (VIS).


Evaluation Criteria

The EHR vendor demonstrates the mechanism to add the following new vaccine information:


Vaccine Name:
Pfizer-BioNTech Covid-19 Vaccine
CVX:
208
NDC:
59267-1000-01
VIS Fully Encoded Text-String
253088698300033211210501
VIS Publication Date
12/08/2022






Notes

These codes will be used to administer the new vaccine in later test steps. 

It is acceptable to demonstrate without saving the information, and a substitute vaccine will be used later in the testing.

Should additional content be needed to complete the new record, the vendor may supply this detail, and the tester will document such information to inform future updates.

The vendor may need to show the screens and omit the commit action. If so, a substitute vaccine may be leveraged for later steps.

 The tester shall document any additional comments or concerns identified by the vendor.

The new vaccine information needs to be added before inventory can be added for a specific vaccine.


1.7.2. Update Vaccine Schedule Information

Test Step Type: SUT_MANUAL
Demonstrates the ability to modify the configuration with a new vaccination schedule.

Test Story

Description

The user responsible for the EHR configuration updates the system with a new vaccine schedule


Comments

No Comments


Pre-condition

The EHR needs to be updated with a new immunization schedule for a vaccine product.


Post-Condition

The updated Patient Immunization Schedule for the vaccine product is available.


Test Objectives

Update Patient Immunization Schedule: The EHR or other clinical software system displays a patient’s anticipated immunization schedule routinely and updates the patient’s schedule when immunization guidelines change.


Evaluation Criteria

The EHR is able to update the patient immunization schedule for the following adult vaccine:


CVX:
208
Vaccine Name:
Pfizer-BioNTech Covid-19 Vaccine
Agegroup 12+
2-dose series separated by 21 days. A series started with Pfizer-BioNTech COVID-19 Vaccine should be completed with this product.
Moderately and severely immunocompromised people:
Administer an additional primary dose at least 28 days after the initial 2-dose primary series.
Booster Dose:
Administer a booster dose at least 6 months after the last dose of a COVID-19 mRNA vaccine primary series (i.e., the 2nd dose or additional primary series dose for moderately or severely immunocompromised people).
  • Should be given to people 18 years of age and older (use of heterologous – mix and match – booster doses is allowed; however, mRNA COVID-19 vaccines are preferred)
  • May be given to people 16 and 17 years of age based on their individual benefits and risks




Notes

The vendor may leverage an external tool to support vaccine schedule information. If so, the vendor should provide documentation regarding how the schedule is updated, how the EHR vendor and providers are notified of the updated schedule, and where in the EHR the modification has impact.

These codes will be used to administer the new vaccine in later test steps. 

It is acceptable to demonstrate without saving the information, and a substitute vaccine will be used later in the testing.

Should additional content be needed to complete the new record, the vendor may supply this detail, and the tester will document such information to inform future updates.

The vendor may need to show the screens and omit the commit action. If so, a substitute vaccine may be leveraged for later steps.

The tester shall document any additional comments or concerns identified by the vendor.

The test is the ability to enter the schedule and it may not reflect the current COVID schedule.


1.7.3. Configure SOAP-based CDC WSDL

Test Step Type: SUT_MANUAL
Demonstrates the ability to configure connectivity using the SOAP-based CDC WSDL.

Test Story

Description

The user responsible for the EHR configuration establishes SOAP-based CDC WSDL configuration and successfully submits a VXU record.





Comments

No Comments


Pre-condition

The EHR is ready to be configured to established connectivity with an IIS.


Post-Condition

Transport is configured to use the SOAP-based CDC WSDL.


Test Objectives

Configure SOAP-based CDC WSDL for Transport: The EHR or other clinical software system configures connectivity using the SOAP-based CDC WSDL and demonstrates compliance with this standard transport.


Evaluation Criteria

Using the test tool and instructions published by NIST at:

 https://hl7v2-iz-cdc-testing.nist.gov/iztool/#/soapConn

 the EHR or other clinical software system is able to successfully execute both Sender (Initiator) test cases:

  • Test Case: SOAPCON_1_BasicMessage_ConnectivityRequest
  • Test Case: SOAPCON_3_SubmitSingleMessage_Message




Notes

All instructions and test details are available at https://hl7v2-iz-cdc-testing.nist.gov/iztool/#/soapConn

The tester shall document any additional comments or concerns identified by the vendor.


1.7.4. Configure Jurisdiction-Specific Vaccine Eligibility Code

Test Step Type: SUT_MANUAL
Demonstrates the ability to configure in-standard local vaccine eligibility codes.

Test Story

Description

The user responsible for the EHR configuration adds a list of jurisdiction dose level vaccine eligibility codes that reflect jurisdiction-funded vaccine campaigns.





Comments

No Comments


Pre-condition

The EHR is ready to be configured to established connectivity with an IIS that uses jurisdiction dose level vaccine eligibility codes for jurisdiction-funded vaccine campaigns.


Post-Condition

Jurisdiction dose level vaccine eligibility codes are configured and available for recording during vaccine administration.


Test Objectives

Add Jurisdiction-Specific Vaccine Eligibility Code: The EHR or other clinical software system demonstrates the ability to configure dose level vaccine eligibility codes per jurisdictional requirements. This includes tracking and exchanging a jurisdiction-specific dose level eligibility code for administered vaccines. Note that this capability only applies to newly administered doses, not historical doses.


Evaluation Criteria

The EHR or other clinical software system demonstrates the addition of the following jurisdiction dose level vaccine eligibility codes:

Code
Label
Definition
IIP021
HEPB09- Privately Insured
Client has private insurance, but is eligible for the vaccine provided based on the following local based rule:
  • Jurisdiction HEPB09 Campaign/Effort
IIP022
HEPB09- Underinsured
Client has private insurance, but it does not cover vaccines, limits the vaccines covered, or caps vaccine coverage at a certain amount and so client is eligible for the vaccine provided based on the following local based rule:
  • Jurisdiction HEPB09 Campaign/Effort
IIP023
HEPB09-Uninsured
Client does not have private insurance coverage and is eligible for the vaccine provided based on the following local based rule:
  • Jurisdiction HEPB09 Campaign/Effort



Notes

For 2021/2022 HIMSS IIP test evaluation, this capability is introduced as a ‘Discovery’ requirement. Developers will be requested to walk through desktop testing to identify current or prospective approaches. They will demonstrate the capability if the functionality exists.  The HIMSS IIP observer will record the process to evaluate whether this capability should be included in future testing.


2. Juana Mariana Vazquez Visit

Juana Mariana Vazquez visits the provider where her immunization history is retrieved from the registry and reconciled with the local information in the medical record to determine vaccines that are due. Vaccinations are ordered and administered. The parents refuse the Polio vaccine due to prior issues. The vaccines are reported to the immunization registry and a vaccine summary is available for the patient.

Test Story

Description

Juana Mariana Vazquez visits the provider where her immunization history is retrieved from the registry and reconciled with the local information in the medical record to determine vaccines that are due. Vaccinations are ordered and administered. The parents refuse the Polio vaccine due to prior issues. The vaccines are reported to the immunization registry and a vaccine summary is available for the patient.


Comments

Pre-condition

Post-Condition

Test Objectives

Evaluation Criteria

Notes

2.1. Query the Registry for Juana Mariana Vazquez

The EHR generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Mariana Vazquez. The Z42 response is used to display, reconcile, and update the immunization information in the EHR.

Test Story

Description

The EHR generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Mariana Vazquez.

Querying the registry will consist of the vendor creating Z44 messages for Juana Mariana Vazquez to be sent to the registry. The response will be processed as part of the 'Display, Reconcile, Import and Update Immunization Information' activity.

Using the Z42 Response to Immunization Registry Query, the EHR displays the Evaluated History and Forecast to the user for reconciliation and update. The vendor will receive information back from the registry and show the ability to view and reconcile, and import the information returned by the registry (NOTE: the Z42 message will be provided either manually, or as part of the tool). This test will also look at the system's ability to view the forecast returned by the registry and create a new forecast after reconciling the information.


Comments

No Comments


Pre-condition

Juana Mariana Vazquez is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juana Mariana Vazquez Initial Data Load.'


Post-Condition

A Z44 Query is generated and submitted to the Immunization Registry/Test tool, and a Z42 response is returned.


Test Objectives

Select New Patient: The EHR or other clinical software system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software system. This information is crucial for identifying and selecting the correct patient.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules.


Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).


Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient (Return Evaluated Immunization History and Forecast (Z42) – HL7 Version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5). The EHR is able to display the evaluated immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if he or she chooses to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.

 

Request/Receive Patient Immunization Data and Identify Source: The EHR stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.

 

View Immunization Forecast: The EHR or other clinical software system provides a view of the immunization forecast provided by the IIS. The display includes the recommended vaccines and their associated dates (e.g., earliest, recommended, past due, latest) for each vaccine included in the forecast.


View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations.


 Review Patient Immunization History: The EHR or other clinical software systems displays vaccine history by vaccine series.

 

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

 

Support for:

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


2.1.1. Select Patient Juana Mariana Vazquez

Test Step Type: SUT_MANUAL
Select patient Juana Mariana Vazquez, distinguishing the patient from other patients with similar demographics (similar names).

Test Story

Description

Juana Mariana Vazquez is selected as the patient and her record is opened in the EHR.


Comments

No Comments


Pre-condition

Juana Mariana Vazquez Initial Data Load completed.


Post-Condition

Juana Mariana Vazquez is the active working patient in the EHR.


Test Objectives

Select New Patient: The EHR or other clinical software system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software system. This information is crucial for identifying and selecting the correct patient. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules.


Evaluation Criteria

Tester shall verify that the product can distinguish Juana Mariana Vazquez from similar sounding names using all of the pediatric demographics. Tester verifies that the product can select the correct patient. The following subset of the patient demographic attributes entered during the initial data load are verified to assure that the correct patient is selected:

Patient Name: First
Juana
Patient Name: Middle
Mariana
Patient Date of Birth:
11/01/2017
Birth Time:
11:05
Patient Gender (Administrative Sex):
F
Multiple Birth Indicator
No
Patient Address: Street
4345 Standish Way
Patient Address: City
Stamford
Patient Address: State
CT
Patient Address: Country
USA
Patient Address: Zip code
06903
Patient Telephone Number:
(203) 555-1212
Patient Telephone Number Type (e.g., home, cell)
Cell


Notes

No Note


2.1.2. Query Registry for vaccination history and forecast for Juana Mariana Vazquez

Test Step Type: SUT_INITIATOR
The EHR generates a Z44 query for immunization history and forecast correctly and without omission according to supplied test data.

Test Story

Description

The provider uses the EHR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.


Comments

No Comments


Pre-condition

Juana Mariana Vazquez Initial Data Load is completed.

Juana Mariana Vazquez is the active working patient in the EHR.


Post-Condition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Mariana Vazquez.


Test Objectives

Request/Receipt of Patient Immunization History:  The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44)  - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

 

Support for:

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.


Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EHR and contains all test data attributes supplied.


Notes

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.4 Assigning Authority
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Vazquez Value-Test Case Fixed
QPD-4.2 Given Name Juana Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Mariana Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Acosta Value-Test Case Fixed
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201711011105 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4345 Standish Way Value-Test Case Fixed
QPD-8.2 Other Designation
QPD-8.3 City Stamford Value-Test Case Fixed
QPD-8.4 State or Province CT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 06903 Value-Test Case Fixed
QPD-8.6 Country USA
QPD-8.7 Address Type L Value-Test Case Fixed
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type CP Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203 Value-Test Case Fixed
QPD-9.7 Local Number 5551212 Value-Test Case Fixed
QPD-10 Multiple birth indicator N Value-Test Case Fixed
QPD-11 Birth order

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1
RCP-2.2 Units
RCP-2.2.1 Identifier RD
RCP-2.2.2 Text Records
RCP-2.2.3 Name of Coding System HL70126

Test Data Specification

Patient Information
Element Data
Patient Name Juana Mariana Vazquez
Mother's Maiden Name Acosta
ID Number 123456
Date/Time of Birth 11/01/2017 11:05
Sex Female
Patient Address 4345 Standish Way Stamford CT 06903 USA
Patient Phone (203)555-1212
Birth Indicator No
Birth Order

2.1.3. View and Compare response to request for vaccination history for Juana Mariana Vazquez

Test Step Type: TA_RESPONDER
The EHR displays the Immunization History results (Z42) returned in response to the Z44 Query and compares to those in the EHR.

Test Story

Description

The Immunization Registry returns an Evaluated History and Forecast (Z42) to the EHR in response to the query for patient (Juana Mariana Vazquez). The provider reviews the immunization history from the registry and compares to the immunization history in the EHR. The provider reviews the information from these sources, identifying information known only to the registry, and identifying information that is more accurately reflected in the local EHR:

The physician accesses the record for Juana Mariana Vazquez and the EHR differentiates:

The following vaccinations are available only to the EHR:


diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 11/20/2021
poliovirus vaccine, inactivated (CVX 10) administered 2/21/2019, -- Adverse Reaction: febrile seizure (e.g. Simple febrile seizure (finding) 432354000) VXC11^convulsions (fits, seizures) within 72 hours of dose^CDCPHINV)
Influenza, injectable, quadrivalent, preservative free (CVX 150) administered 10/15/2021


The EHR differentiates the following vaccinations which differ between the EHR and the IIS:


For the hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 12/20/2017, that EHR displays different text for the IIS (which documents a Non-specific formulation) and EHR (which documents hepatitis B vaccine, pediatric or pediatric/adolescent dosage) for Vaccine administered


The EHR differentiates the following vaccinations that are available from both the IIS that and the local EHR:


measles, mumps, rubella virus vaccine (CVX 03) administered 8/22/2018 (an invalid dose)


The EHR differentiates the following vaccinations that are available from the IIS that are not known to the local EHR:


hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 11/01/2017
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 05/20/2018
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 1/22/2018
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 3/23/2018
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 5/22/2018
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 2/21/2019
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 1/22/2018
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 3/23/2018
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/22/2018
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 11/21/2018
poliovirus vaccine, inactivated (CVX 10) administered 1/22/2018
poliovirus vaccine, inactivated (CVX 10) administered 3/23/2018
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 1/22/2018
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 3/23/2018
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/22/2018
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 1/11/2019
rotavirus, live, monovalent vaccine (CVX 119) administered 1/22/2018
rotavirus, live, monovalent vaccine (CVX 119) administered 3/23/2018
Influenza, injectable, quadrivalent, preservative free (CVX 150) administered 9/25/2018
Influenza, injectable, quadrivalent, preservative free (CVX 150) administered 10/29/2018
Influenza, injectable, quadrivalent, preservative free (CVX 150) administered 10/2/2019
Influenza, injectable, quadrivalent, preservative free (CVX 150) administered 11/4/2020
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 11/23/2018
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 5/23/2019
measles, mumps, rubella virus vaccine (CVX 03) administered 9/22/2021
Varicella virus vaccine (CVX 21) administered 12/15/2019



Comments

No Comments


Pre-condition

Juana Mariana Vazquez Initial Data Load is completed.

Juana Mariana Vazquez is the active working patient in the EHR.

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR.


Post-Condition

Evaluated Immunization History returned from the registry is reviewed and compared to the immunizations in the patient record (Juana Mariana Vazquez).


Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 Version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient (Return Evaluated Immunization History and Forecast (Z42) – HL7 Version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5). The EHR is able to display the evaluated immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if they choose to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.

Review Patient Immunization History: The EHR or other clinical software system displays vaccine history by vaccine series.


Support for:

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.


Evaluation Criteria

1. The EHR is able to receive the response from the Immunization Registry.

2. The EHR displays the information returned from the Immunization Registry according to the Juror Document.

- Complete review for Polio administered 3/23/2018, MMR 8/22/2018.

- remaining vaccines may be reviewed only for the vaccine name and date administered.

3. The EHR is able to differentiate the vaccines in the comparison between the EHR and the vaccination history.


Notes

The juror document also contains the verification content for the immunization forecast, which is tested and graded separately at step 5: View the vaccination history for Juana Mariana Vazquez. The criteria for this step is tested separately here and graded only with respect to the vaccine history.

The EHR must minimally display the vaccine administered and the date of the immunization.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031001020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Vazquez
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Mariana
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Acosta
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201711011105
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4345 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country USA
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type CP
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551212
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Vazquez
PID-5.2 Given Name Juana
PID-5.3 Second and Further Given Names or Initials Thereof Mariana
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 201711011105
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID SH
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SH
ORC-17.2 Text Shoreline Hospital
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 1970278
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20171101
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Carter
RXA-10.3 Given Name Jane
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code L
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20171220
RXA-5 Administered Code
RXA-5.1 Identifier 45
RXA-5.2 Text hepatitis B vaccine, unspecified formulation
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180520
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180122
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180323
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180522
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20190221
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180122
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180323
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180522
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20181121
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180122
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180323
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180122
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180323
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180522
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20190111
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180122
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 1.0
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180323
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 1.0
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180925
RXA-5 Administered Code
RXA-5.1 Identifier 150
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20181029
RXA-5 Administered Code
RXA-5.1 Identifier 150
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20191002
RXA-5 Administered Code
RXA-5.1 Identifier 150
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20201104
RXA-5 Administered Code
RXA-5.1 Identifier 150
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20181123
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20190523
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180822
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text measles, mumps, rubella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210922
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text measles, mumps, rubella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20191215
RXA-5 Administered Code
RXA-5.1 Identifier 21
RXA-5.2 Text varicella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180429
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221021
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288
RXR-1.2 Text Oral
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288
RXR-1.2 Text Oral
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RA
RXR-2.2 Text Right Arm
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text hepatitis B vaccine, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171101

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171101

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171101

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171101

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171101

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text hepatitis B vaccine, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171220

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171220

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171220

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171220

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171220

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text hepatitis B vaccine, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180520

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180520

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180520

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180520

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180520

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181121

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181121

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181121

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181121

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181121

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 31044-1
OBX-3.2 Text Reaction
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC11
OBX-5.2 Text convulsions (fits, seizures) within 72 hours of dose
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190111

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190111

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190111

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190111

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190111

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180925

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180925

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180925

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180925

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180925

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181029

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181029

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181029

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181029

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181029

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20191002

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20191002

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20201104

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20201104

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181123

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181123

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181123

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181123

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180822

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180822

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value N
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180822

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30982-3
OBX-3.2 Text Reason code
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 264499004
OBX-5.2 Text Early
OBX-5.3 Name of Coding System SCT
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180822

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210922

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210922

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210922

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210922

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210922

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella virus vaccine
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20191215

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20191215

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20191215

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20191215

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20191215

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180429

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180429

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20180429
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180429

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20180429
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180429

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20190430
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180429

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180429

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221021

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221021

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20220901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221021

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20220901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221021

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20211031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20211031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20211031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20211031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Juana Mariana Vazquez
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juana Mariana Vazquez
Date of Birth 11/01/2017
Sex Female
Address 1
Street 4345 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Maria Merida Acosta
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Shoreline Hospital
Vaccine Group hepatitis B vaccine, unspecified formulation
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 11/01/2017
Date/Time Administration-End 11/01/2017
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name Jane Carter
ID Number
Administered-at Location
Facility ID SH
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Shoreline Pediatrics
Vaccine Group hepatitis B vaccine, unspecified formulation
Vaccine Administered hepatitis B vaccine, unspecified formulation
Refusal Reason
Date/Time Administration-Start 12/20/2017
Date/Time Administration-End 12/20/2017
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name Sandra Molina
ID Number
Administered-at Location
Facility ID SP
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group hepatitis B vaccine, unspecified formulation
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 05/20/2018
Date/Time Administration-End 05/20/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Refusal Reason
Date/Time Administration-Start 01/22/2018
Date/Time Administration-End 01/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 03/23/2018
Date/Time Administration-End 03/23/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 05/22/2018
Date/Time Administration-End 05/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 02/21/2019
Date/Time Administration-End 02/21/2019
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 01/22/2018
Date/Time Administration-End 01/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Thigh
Substance Manufacturer Name Merck and Co Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 03/23/2018
Date/Time Administration-End 03/23/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name Merck and Co Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 05/22/2018
Date/Time Administration-End 05/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Thigh
Substance Manufacturer Name Merck and Co Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 11/21/2018
Date/Time Administration-End 11/21/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name Merck and Co Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 01/22/2018
Date/Time Administration-End 01/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Arm
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 03/23/2018
Date/Time Administration-End 03/23/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Arm
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/22/2018
Date/Time Administration-End 01/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 03/23/2018
Date/Time Administration-End 03/23/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 05/22/2018
Date/Time Administration-End 05/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/11/2019
Date/Time Administration-End 01/11/2019
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 01/22/2018
Date/Time Administration-End 01/22/2018
Administered Amount 1.0
Administered Units of Measure mL
Route of Administration Oral
Administration Site
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 03/23/2018
Date/Time Administration-End 03/23/2018
Administered Amount 1.0
Administered Units of Measure mL
Route of Administration Oral
Administration Site
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable, quadrivalent, preservative free
Refusal Reason
Date/Time Administration-Start 09/25/2018
Date/Time Administration-End 09/25/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable, quadrivalent, preservative free
Refusal Reason
Date/Time Administration-Start 10/29/2018
Date/Time Administration-End 10/29/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable, quadrivalent, preservative free
Refusal Reason
Date/Time Administration-Start 10/02/2019
Date/Time Administration-End 10/02/2019
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable, quadrivalent, preservative free
Refusal Reason
Date/Time Administration-Start 11/04/2020
Date/Time Administration-End 11/04/2020
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 11/23/2018
Date/Time Administration-End 11/23/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 05/23/2019
Date/Time Administration-End 05/23/2019
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Shoreline Pediatrics
Vaccine Group MMR
Vaccine Administered measles, mumps, rubella virus vaccine
Refusal Reason
Date/Time Administration-Start 08/22/2018
Date/Time Administration-End 08/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Thigh
Substance Manufacturer Name Merck and Co Inc
Administration Notes new immunization record
Administering Provider
Name Sandra Molina
ID Number
Administered-at Location
Facility ID SP
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose NO
Validity Reason Early
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group MMR
Vaccine Administered measles, mumps, rubella virus vaccine
Refusal Reason
Date/Time Administration-Start 09/22/2021
Date/Time Administration-End 09/22/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Arm
Substance Manufacturer Name Merck and Co Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Varicella virus vaccine
Vaccine Administered varicella virus vaccine
Refusal Reason
Date/Time Administration-Start 12/15/2019
Date/Time Administration-End 12/15/2019
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Right Arm
Substance Manufacturer Name Merck and Co Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group IPV
Vaccine Due Date 04/29/2018
Earliest Date to Give 04/29/2018
Latest Date to Give
Date When Vaccine Overdue 04/30/2019
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2022
Earliest Date to Give 09/01/2022
Latest Date to Give
Date When Vaccine Overdue 10/31/2023
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 10/31/2021
Earliest Date to Give 10/31/2021
Latest Date to Give
Date When Vaccine Overdue 10/31/2023
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 10/31/2021
Earliest Date to Give 10/31/2021
Latest Date to Give
Date When Vaccine Overdue 10/31/2023
Status in Immunization Series
Forecast Reason

2.1.4. Mark first MMR Dose as Invalid

Test Step Type: SUT_MANUAL
Identify the first MMR dose which is given too early, as invalid. If the EHR does not already flagged the first MMR as invalid, the provider updates the first MMR to indicate it is invalid as it was given too early (as notified by the registry).

Test Story

Description

If the EHR does not already flag the first MMR as invalid, the provider updates the first MMR to indicate it is "invalid" as it was given too early (as notified by the registry).


Comments

If the EHR already recognizes the dose as invalid, then this step may be skipped.


Pre-condition

Initial Data Load - Step 2: Enter Initial Immunization Data for Juana Mariana Vazquez: Immunizations from practice.


Post-Condition

MMR status for the first MMR dose is set to invalid.


Test Objectives

dose validity is an important aspect of:

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations.


Evaluation Criteria

Evaluation Criteria: The vendor is able to record that the first MMR vaccination dose is invalid with a reason that it was given too early, and therefore the dose administered on 9/22/2021 should indicated dose '1'.







Notes

In the steps that follow, the MMR returned from the registry will be imported and the vaccine forecasting steps will further verify the correct documentation of the dose that will be imported from the registry as dose '1'.





2.1.5. View the vaccination forecast for Juana Mariana Vazquez

Test Step Type: TA_RESPONDER
Vendor can successfully display the current Immunization Forecast (vaccination names and recommended vaccination dates) as returned by the Registry (Z42).

Test Story

Description

The physician accesses the record for Juana Mariana Vazquez and:

- Displays the registry forecast as returned by the immunization registry.


Comments

No Comments


Pre-condition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR.


Post-Condition

Immunization Forecast returned from the registry has been displayed to the user.


Test Objectives

View Immunization Forecast: The EHR or other clinical software system provides a view of the immunization forecast provided by the IIS. The display includes the recommended vaccines and their associated dates (e.g., earliest, recommended, past due, latest) for each vaccine included in the forecast.



Evaluation Criteria

1. The EHR displays the information returned from the Immunization Registry according to the Juror Document.

2. Verify that all forecast vaccines and dates returned by the registry are displayed to the user.


Notes

The verification content for the vaccine forecast also is part of the juror document in the prior step 3: View and Compare response to request for vaccination history for Juana Mariana Vazquez. The criteria for this step is tested separately here and graded only with respect to the vaccine forecast. Date when Vaccine Overdue may be omitted for the Influenza Vaccine.

For MMR, the 2nd dose is due 10/31/2020 according to the schedule. Since the first one was given too early, the child is behind. Verify that the EHR shows all 3 dates returned by the registry:

- Earliest Date to Give

- Vaccine Due Date

- Date When Vaccine Overdue



Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031001020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Vazquez
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Mariana
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Acosta
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201711011105
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4345 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country USA
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type CP
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551212
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Vazquez
PID-5.2 Given Name Juana
PID-5.3 Second and Further Given Names or Initials Thereof Mariana
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 201711011105
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID SH
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SH
ORC-17.2 Text Shoreline Hospital
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 1970278
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20171101
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Carter
RXA-10.3 Given Name Jane
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code L
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20171220
RXA-5 Administered Code
RXA-5.1 Identifier 45
RXA-5.2 Text hepatitis B vaccine, unspecified formulation
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180520
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180122
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180323
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180522
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20190221
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180122
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180323
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180522
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20181121
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180122
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180323
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180122
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180323
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180522
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20190111
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180122
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 1.0
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180323
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 1.0
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180925
RXA-5 Administered Code
RXA-5.1 Identifier 150
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.50
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20181029
RXA-5 Administered Code
RXA-5.1 Identifier 150
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.50
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20191002
RXA-5 Administered Code
RXA-5.1 Identifier 150
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20201104
RXA-5 Administered Code
RXA-5.1 Identifier 150
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.50
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20181123
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20190523
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180822
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text measles, mumps, rubella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210922
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text measles, mumps, rubella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20191215
RXA-5 Administered Code
RXA-5.1 Identifier 21
RXA-5.2 Text varicella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180429
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221021
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288
RXR-1.2 Text Oral
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288
RXR-1.2 Text Oral
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RA
RXR-2.2 Text Right Arm
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text hepatitis B vaccine, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171101

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171101

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171101

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171101

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171101

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text hepatitis B vaccine, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171220

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171220

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171220

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171220

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171220

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text hepatitis B vaccine, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180520

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180520

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180520

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180520

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180520

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181121

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181121

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181121

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181121

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181121

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190111

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190111

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190111

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190111

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190111

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180925

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180925

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180925

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180925

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180925

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181029

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181029

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181029

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181029

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181029

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20191002

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20191002

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20201104

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20201104

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181123

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181123

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181123

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20181123

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20190523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180822

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180822

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value N
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180822

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30982-3
OBX-3.2 Text Reason code
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 264499004
OBX-5.2 Text Early
OBX-5.3 Name of Coding System SCT
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180822

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210922

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210922

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210922

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210922

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210922

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella virus vaccine
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20191215

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20191215

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20191215

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20191215

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20191215

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180429

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180429

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20180429
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180429

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20180429
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180429

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20190430
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180429

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180429

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221021

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221021

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20220901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221021

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20220901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221021

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20211031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20211031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20211031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20211031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Juana Mariana Vazquez
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juana Mariana Vazquez
Date of Birth 11/01/2017
Sex Female
Address 1
Street 4345 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Maria Merida Acosta
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Shoreline Hospital
Vaccine Group hepatitis B vaccine, unspecified formulation
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 11/01/2017
Date/Time Administration-End 11/01/2017
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name Jane Carter
ID Number
Administered-at Location
Facility ID SH
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Shoreline Pediatrics
Vaccine Group hepatitis B vaccine, unspecified formulation
Vaccine Administered hepatitis B vaccine, unspecified formulation
Refusal Reason
Date/Time Administration-Start 12/20/2017
Date/Time Administration-End 12/20/2017
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name Sandra Molina
ID Number
Administered-at Location
Facility ID SP
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group hepatitis B vaccine, unspecified formulation
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 05/20/2018
Date/Time Administration-End 05/20/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Refusal Reason
Date/Time Administration-Start 01/22/2018
Date/Time Administration-End 01/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 03/23/2018
Date/Time Administration-End 03/23/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 05/22/2018
Date/Time Administration-End 05/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 02/21/2019
Date/Time Administration-End 02/21/2019
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 01/22/2018
Date/Time Administration-End 01/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Thigh
Substance Manufacturer Name Merck and Co Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 03/23/2018
Date/Time Administration-End 03/23/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name Merck and Co Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 05/22/2018
Date/Time Administration-End 05/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Thigh
Substance Manufacturer Name Merck and Co Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 11/21/2018
Date/Time Administration-End 11/21/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name Merck and Co Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 01/22/2018
Date/Time Administration-End 01/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Arm
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 03/23/2018
Date/Time Administration-End 03/23/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Arm
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/22/2018
Date/Time Administration-End 01/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 03/23/2018
Date/Time Administration-End 03/23/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 05/22/2018
Date/Time Administration-End 05/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/11/2019
Date/Time Administration-End 01/11/2019
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 01/22/2018
Date/Time Administration-End 01/22/2018
Administered Amount 1.0
Administered Units of Measure mL
Route of Administration Oral
Administration Site
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 03/23/2018
Date/Time Administration-End 03/23/2018
Administered Amount 1.0
Administered Units of Measure mL
Route of Administration Oral
Administration Site
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable, quadrivalent, preservative free
Refusal Reason
Date/Time Administration-Start 09/25/2018
Date/Time Administration-End 09/25/2018
Administered Amount 0.50
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable, quadrivalent, preservative free
Refusal Reason
Date/Time Administration-Start 10/29/2018
Date/Time Administration-End 10/29/2018
Administered Amount 0.50
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable, quadrivalent, preservative free
Refusal Reason
Date/Time Administration-Start 10/02/2019
Date/Time Administration-End 10/02/2019
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable, quadrivalent, preservative free
Refusal Reason
Date/Time Administration-Start 11/04/2020
Date/Time Administration-End 11/04/2020
Administered Amount 0.50
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 11/23/2018
Date/Time Administration-End 11/23/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 05/23/2019
Date/Time Administration-End 05/23/2019
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Shoreline Pediatrics
Vaccine Group MMR
Vaccine Administered measles, mumps, rubella virus vaccine
Refusal Reason
Date/Time Administration-Start 08/22/2018
Date/Time Administration-End 08/22/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Thigh
Substance Manufacturer Name Merck and Co Inc
Administration Notes new immunization record
Administering Provider
Name Sandra Molina
ID Number
Administered-at Location
Facility ID SP
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose NO
Validity Reason Early
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group MMR
Vaccine Administered measles, mumps, rubella virus vaccine
Refusal Reason
Date/Time Administration-Start 09/22/2021
Date/Time Administration-End 09/22/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Arm
Substance Manufacturer Name Merck and Co Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Varicella virus vaccine
Vaccine Administered varicella virus vaccine
Refusal Reason
Date/Time Administration-Start 12/15/2019
Date/Time Administration-End 12/15/2019
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Right Arm
Substance Manufacturer Name Merck and Co Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group IPV
Vaccine Due Date 04/29/2018
Earliest Date to Give 04/29/2018
Latest Date to Give
Date When Vaccine Overdue 04/30/2019
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2022
Earliest Date to Give 09/01/2022
Latest Date to Give
Date When Vaccine Overdue 10/31/2023
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 10/31/2021
Earliest Date to Give 10/31/2021
Latest Date to Give
Date When Vaccine Overdue 10/31/2023
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 10/31/2021
Earliest Date to Give 10/31/2021
Latest Date to Give
Date When Vaccine Overdue 10/31/2023
Status in Immunization Series
Forecast Reason

2.1.6. Reconcile and import vaccinations from Evaluated History and Forecast for Juana Mariana Vazquez

Test Step Type: SUT_MANUAL
The Provider uses the EHR to compare the immunization history results (Z42) returned by the Immunization Registry in response to the Z44 Query with the immunization history in the local system and reconcile (import/update) records.

Test Story

Description

Juana Mariana Vazquez immunization registry provided Evaluated History and Forecast is reconciled with the immunization history information in the EHR.


Comments

No Comments


Pre-condition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR, and the response is available in the EHR for reconciliation and import.


Post-Condition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Vazquez).


Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.

 

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if they choose to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.

 

Review Patient Immunization History: The EHR or other clinical software systems displays vaccine history by vaccine series.

 

Support for:

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.


Evaluation Criteria

The user imports the vaccination, date administered, and documents adverse reactions reconciled from the returned vaccinations as follows:

  • Vaccinations NOT imported:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 12/20/2017
measles, mumps, and rubella virus vaccine (CVX 03) administered 8/22/2018
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 11/20/2021 [known only to EHR, not available from IIS]
poliovirus vaccine, inactivated (CVX 10) administered 2/21/2019 [known only to EHR, not available from IIS], adverse reaction: VXC12^fever of >40.5C (105F) within 48 hours of dose^CDCPHINVS
Influenza, injectable, quadrivalent, preservative free (CVX 150) administered 10/15/2021 [known only to EHR, not available from IIS]


  • Vaccinations imported:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 11/01/2017
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 05/20/2018
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 1/22/2018
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 3/23/2018
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 5/22/2018
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 2/21/2019
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 1/22/2018
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 3/23/2018
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/22/2018
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 11/21/2018
poliovirus vaccine, inactivated (CVX 10) administered 1/22/2018
poliovirus vaccine, inactivated (CVX 10) administered 3/23/2018
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 1/22/2018
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 3/23/2018
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/22/2018
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 1/11/2019
rotavirus, live, monovalent vaccine (CVX 119) administered 1/22/2018
rotavirus, live, monovalent vaccine (CVX 119) administered 3/23/2018
Influenza, injectable, quadrivalent, preservative free (CVX 150) administered 9/25/2018
Influenza, injectable, quadrivalent, preservative free (CVX 150) administered 10/29/2018
Influenza, injectable, quadrivalent, preservative free (CVX 150) administered 10/2/2019
Influenza, injectable, quadrivalent, preservative free (CVX 150) administered 11/4/2020
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 11/23/2018
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 5/23/2019
measles, mumps, rubella virus vaccine (CVX 03) administered 9/22/2021
Varicella virus vaccine (CVX 21) administered 12/15/2019


  • The tester verifies that the Reconciled Patient Immunization History can be displayed to the user.

Notes

No Note


2.1.7. View the updated vaccination forecast for Juana Mariana Vazquez

Test Step Type: SUT_MANUAL
Using the reconciled vaccine history information, the EHR displays the current Immunization Forecast to the user for Juana Mariana Vazquez.

Test Story

Description

Once the vaccine history is reconciled in the EHR, the vaccine forecast is updated.


Comments

No Comments


Pre-condition

EHR Vaccine History is Reconciled with Immunization History from the IIS (previous step 'Reconcile and import vaccinations from Evaluated History and Forecast returned by the Registry for Juana Mariana Vazquez').


Post-Condition

An updated vaccine forecast based upon the reconciled vaccine history is available to the user.


Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations.



Evaluation Criteria

Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:

  • Verify that the EHR does not include in reconciled vaccine forecast:


IPV
due on 4/29/2018


  • Verify that the EHR includes in reconciled vaccine forecast:


IPV
due on 10/31/2021
MMR
due on 10/31/2021
Varicella
due on 10/31/2021
influenza, unspecified formulation
due on 09/01/2022 or later (annual recommendation – specific date may vary somewhat)



Notes

The due date must be in range for the date shown. Vaccine forecast dates may be plus or minus 10 days to accommodate differences in date handling.

Since influenza is seasonal, forecasting of influenza vaccine may vary by test date. Once the influenza season has past, the next influenza vaccine forecast will be for the next season. The forecasting for children who are playing immunization catch-up may differ from the standard immunization forecast. Tester should document incidences where influenza vaccine is not forecasted and verify that the rationale for the omission is due to the date of the test. Variations relating to IPV refusals and catch-up should also be documented by the tester. Overdue date may be omitted for influenza vaccine. While there is not an expected recommendation for the earliest date to give for influenza vaccine, this may appear in some EHR implementations. Tester should note if this is included.

Further variation should be documented in the notable exceptions, but minimally each forecast vaccine must be present.


2.2. Juana Mariana Vazquez, Enter Orders and Immunizations

The provider selects to order IPV and views information about the prior febrile seizure post-IPV vaccine.

Test Story

Description

This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients.


Comments

No Comments


Pre-condition

Juana Mariana Vazquez is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juana Mariana Vazquez Initial Data Load.’


Post-Condition

Visit orders are entered in Juana Mariana Vazquez's record.


Test Objectives

Notify of Previous Adverse Event: The EHR or other clinical software system alerts providers to previous adverse events for a specific patient, in order to inform clinical decision-making when providers view an existing immunization record.


Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed.

 

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.


 Receive Dose Not Indicated Alert Upon Vaccine Administration: The system notifies the individual administering a vaccine that the vaccine is inconsistent with expected timing intervals as suggested by the vaccine forecast. The method and timing of notification can be specified to meet local clinical workflow. This requirement is a “failsafe” mechanism in case the provider orders a vaccine dose that is inconsistent with appropriate timing intervals.


Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine).


Receive Dose Not Indicated Alert Upon Vaccine Administration: The system notifies the individual administering a vaccine that the vaccine is inconsistent with expected timing intervals as suggested by the vaccine forecast. The method and timing of notification can be specified to meet local clinical workflow. This requirement is a “failsafe” mechanism in case the provider orders a vaccine dose that is inconsistent with appropriate timing intervals.


Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.

 

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.


Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or prefilled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS.

 

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.


Data Quality Checks: The EHR or other clinical software system integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

  • 2008: Indicates that either a refusal reason was messaged in RXA-18 when the completion status in RXA-20 was not RE or a valid refusal reason was not messaged when the completion status was RE
  • 2014: Indicates that the administration amount is inconsistent with the vaccine administered
  • 2016: Indicates that the administration route is inconsistent with the vaccine administered 

Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


2.2.1. Order IPV and view prior reaction

Test Step Type: SUT_MANUAL
The provider selects to order IPV and views information about the prior febrile seizure post-IPV vaccine.

Test Story

Description

The provider accesses the record for Juana Mariana Vazquez and:

- Selects order for IPV and views information about the prior febrile seizure post-IPV vaccine.

- IPV is ordered for the patient.


Comments

In this step, the order is recorded after receiving the alert. This step is followed by parental refusal when the administration is attempted.


Pre-condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR.


Post-Condition

IPV order entered in patient record. User notified of history of adverse reaction to IPV (febrile seizures).


Test Objectives

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.

 

Notify of Previous Adverse Event: The EHR or other clinical software system alerts providers to previous adverse events for a specific patient, in order to inform clinical decision-making when providers view an existing immunization record.


Evaluation Criteria

The EHR records the following order information and alert. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

Entered By
Sandra Molina
Ordering Provider
Frank Smith
Entering Organization
Shoreline Pediatrics
Vaccine Event information source
New immunization record (NIP001 00)
Value/Text for Vaccine Type
IPV (CVX 10)
Date/Time Vaccine Refusal was recorded
Current Date
Alert
Alerts user to information about the prior febrile seizure post-IPV vaccine

Notes

No Note


2.2.2. Vaccine Refusal Data Quality Checks

Test Step Type: SUT_MANUAL
The provider attempts to document vaccine refusal information for Juana Mariana Vazquez in the EHR. Vaccination refusal data quality checks are verified during data entry.

Test Story

Description

The provider attempts to document vaccine refusal information for the immunization for Juana Mariana Vazquez. These data quality checks primarily relate to improving vaccine refusal information and associated observations that will be included when submitting data to the immunization registry.



Comments

Evaluates EHR functions for verifying data quality of vaccine refusal data and associated observations used for reporting vaccinations to the immunization registry. There is no transaction associated with this test step.


Pre-condition

Order is placed for the IPV vaccine.



Post-Condition

The EHR has alerted the provider for each of the vaccine refusal data quality checks verified for Juana Mariana Vazquez.



Test Objectives

Data Quality Checks: Integrate additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

  - 2008 : Indicates that either a refusal reason was messaged in RXA-18 when the completion status in RXA-20 was not RE or a valid refusal reason was not messaged when the completion status was RE.




Evaluation Criteria

Evaluation Criteria: During the course of data entry for the variant information below, the EHR triggers the following data quality issues:

  • Triggers Error that completion status indicates a Refusal Reason is documented, but completion status is not documented as RE  (2008)
Substance/Treatment Refusal Reason
Parental decision (NIP002 00)

Completion Status
CPTriggers Error that completion status indicates a Refusal Reason is documented, but completion status is not documented as RE  (2008)
Date/Time Vaccine Deferral was recorded
Current Date

Refusal Reason
Parental decision (NIP002 00)

Deferral Status
Deferred


  • Triggers Error a completion status of RE, but no valid Refusal Reason is documented (2008)
Substance/Treatment Refusal Reason
not documented Triggers Error a completion status of RE, but no valid Refusal Reason is documented (2008)
Completion Status
RE

Date/Time Vaccine Deferral was recorded
Current Date

Refusal Reason
not documentedTriggers Error a completion status of RE, but no valid Refusal Reason is documented (2008)
Deferral Status
Deferred

  • Triggers Error a completion status of RE, but no valid Refusal Reason is documented (2008)
Substance/Treatment Refusal Reason
Concern Triggers Error a completion status of RE, but no valid Refusal Reason is documented (2008)
Completion Status
RE

Date/Time Vaccine Deferral was recorded
Current Date

Refusal Reason
Reason documented not in  value set (NIP002 - Substance refusal reason)
Triggers Error a completion status of RE, but no valid Refusal Reason is documented (2008)
Deferral Status
Deferred



Notes

The full vaccination refusal details are provided here to facilitate the documentation constraints and/or screens that may be required by the vendor in order to attempt to document the data of interest, but these are not verified until the next step. Only those attributes specified that are anticipated to result in data quality alerts are required for this step.







2.2.3. IPV Parental Refusal

Test Step Type: SUT_MANUAL
Documents mother’s refusal for IPV vaccine indicating the parent decision, the reason and documents a deferral.

Test Story

Description

The mother is concerned about administering the IPV due to the prior adverse reaction and refuses to have the child immunized for IPV. The provider documents mother's refusal for IPV vaccine indicating the parent decision, the reason and documents a deferral at the time of attempted administration.



Comments

No Comments


Pre-condition

Prior Immunization History loaded and reconciled from the Immunization Registry. Order is entered for IPV. Provider has been alerted to prior adverse reaction to IPV of febrile seizures.


Post-Condition

Vaccine non-administration due to parental refusal is documented in the patient record. Deferral is recorded.


Test Objectives

Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed.


Evaluation Criteria

The EHR documents the non-administration of the IPV due to the parental refusal. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

Substance/Treatment Refusal Reason
Parental decision (NIP002 00)
Completion Status
RE
Date/Time Vaccine Deferral was recorded
Current Date
Refusal Reason
Parental decision (NIP002 00)
Deferral Status
Deferred

Notes

No Note


2.2.4. Enter Immunization Data for MMR Given 2 Weeks Prior

Test Step Type: SUT_MANUAL
Patient History from the parent for the latest MMR vaccine that was given 2 weeks prior to the current visit is entered into the EHR. This is a pre-condition to the attempt to enter the varicella vaccine order.

Test Story

Description

The EHR vendor loads immunization history data for an MMR dose entered 2 weeks prior to the current visit date and an MMR dose that was given too early. These MMR doses serve to seed checking for the condition that it is too early to give a live vaccine in TestCaseGroup: Juana Mariana Vazquez Visit, TestCase: Juana Mariana Vazquez, Enter Orders and Immunizations, TestStep: Attempt to order Varicella Dose.


Comments

No Comments


Pre-condition

The EHR has recorded all of the pediatric demographic data in the record created for Juana Mariana Vazquez. All test steps that are part of the Query the Registry for Juana Mariana test steps are completed, including the vaccination forecasting.


Post-Condition

The immunization history of the MMR that was administered 2 weeks prior to the test date is loaded into the record created for Juana Mariana Vazquez.


Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

 

Request/Receive Patient Immunization Data and Identify Source: The EHR stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

 

Supporting data for:

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.

Receive Dose Not Indicated Alert Upon Vaccine Administration: The system notifies the individual administering a vaccine that the vaccine is inconsistent with expected timing intervals as suggested by the vaccine forecast. The method and timing of notification can be specified to meet local clinical workflow. This requirement is a “failsafe” mechanism in case the provider orders a vaccine dose that is inconsistent with appropriate timing intervals.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization data known to the local practice as provided, with all required attributes indicated by [Y]. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

Vaccine from Practice MMR II

Entered By
Sandra Molina
Ordering Provider
Frank Smith
Entering Organization
Shoreline Pediatrics
Administration Notes (Vaccine Event information source)
Historical information – from parent’s written record (NIP001 03)
Date/Time of Start of Administration
14 days prior to the Current Date
Vaccine Administered
measles, mumps and rubella virus vaccine (CVX 03, NDC 00006-4681-01 – MMR II)
Administered Amount (of Vaccine)
0.5
Administered Units (of Measure)
mL
Administering Provider
Sandra Molina
Administered-at Location
400 Shoreline Drive, Stamford Connecticut 06901
Lot Number
0934GG
Substance Expiration Date
12/31/2023
Substance Manufacturer.
Merck and Co Inc (MVX MSD)
Completion Status
Completed (CP)
Route of Administration
Subcutaneous (NCIT: C28399, HL70162: SC)
Administration Site
Left Arm (HL70163: LA)

Notes

The MMR doses serve to seed checking for the condition that it is too early to give a live vaccine in TestCaseGroup: Juana Mariana Vazquez Visit, TestCase: Juana Mariana Vazquez, Enter Orders and Immunizations, TestStep: Attempt to order Varicella Dose.


2.2.5. Attempt to Order Varicella Dose

Test Step Type: SUT_MANUAL
The provider attempts to give a Varicella dose and is warned that it is too soon to give a live vaccine dose.

Test Story

Description

The provider attempts to give a Varicella dose and is warned that it is too soon to give a live vaccine dose.


Comments

No Comments


Pre-condition

Initial data load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. MMR dose entered at 14 days prior to the current date in TestCaseGroup: Juana Mariana Vazquez Visit, TestCase: Juana Mariana Vazquez, Enter Immunization Data for MMR Given 2 Weeks Prior.


Post-Condition

The provider has been issued a warning that it is too soon to give another live virus dose.


Test Objectives

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.


Evaluation Criteria

There should be a warning that the attempt to give a new Varicella Dose is too early - should get warning that 28 days must pass between 2 live virus vaccines if not administered at the same time due to the prior MMR vaccination 14 days earlier.


Notes

If the checking that the dose is too early is handled in the forecast logic rather than the orders interface, this is acceptable to demonstrate the capability.

It can be expressed where it is not part of the recommended forecast and showing it is not 'due' or recommended until a later date.




2.2.6. Order Influenza Vaccine

Test Step Type: SUT_MANUAL
The provider selects to order Influenza vaccine.

Test Story

Description

The physician accesses the record for Juana Mariana Vazquez and:

- Selects order for Influenza vaccine.


Comments

This order is a pre-condition to the following two steps related to recording the Influenza vaccine.


Pre-condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR.


Post-Condition

Influenza order entered in patient record.


Test Objectives

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.


Evaluation Criteria

The EHR records the following order information. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

Entered BY
Sandra Molina
Ordering Provider
Frank Smith
Entering Organization
Shoreline Pediatrics
Vaccine Event information source
New immunization record (NIP001 00)
Value/Text for Vaccine Type
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0890-41)
Date/Time Vaccine was recorded
Current Date

Notes

No Note


2.2.7. Vaccine Dosing and Administration Data Quality Checks

Test Step Type: SUT_MANUAL
The provider attempts to document vaccine dosing and administration information for Juana Mariana Vazquez in the EHR. Vaccination dosing and administration data quality checks are verified during data entry.

Test Story

Description

The provider attempts to document vaccine route, site, and administration amount for the influenza immunization for Juana Mariana Vazquez. These data quality checks primarily relate to improving vaccine dosing and administration information that will be included in the vaccination details when submitting data to the immunization registry.

The nurse documents administration route for the IM inactivated influenza vaccine as 'intranasal':

- Is alerted when documenting "intranasal" for intramuscular inactivated influenza vaccine.

- Is alerted when documenting the incorrect administration amount for the vaccine administered.


Comments

Evaluates EHR functions for verifying data quality of vaccine dosing and administration data used for reporting vaccinations to the immunization registry. There is no transaction associated with this test step. 


Pre-condition

Order is placed for intramuscular inactivated influenza vaccine.


Post-Condition

The EHR has alerted the provider for each of the vaccine dosing and administration data quality checks verified for Juana Mariana Vazquez.


Test Objectives

Data Quality Checks: Integrate additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

 

Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

  - 2014: Indicates that the administration amount is inconsistent with the vaccine administered

  - 2016 : Indicates that the administration route is inconsistent with the vaccine administered 

Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The National Drug Code and manufacturer data elements (NDC) is embedded in the Global Trade Item Number (GTIN). Using mapping tables, the manufacturer can be determined from the NDC Code. The NDC and manufacturer data elements are later transmitted to an IIS by cross walking/mapping from the GTIN. The software system records this information as structured data elements.


Evaluation Criteria

Evaluation Criteria: During the course of data entry for the variant information below, the EHR triggers the following data quality issues:

  • Triggers Error that the administration amount is inconsistent with the vaccine administered (2014)
  • Triggers Error that the administration route is inconsistent with the vaccine administered (2016)

The EHR Records the following vaccine administration information:

Entered By
Sandra Molina

Ordering Provider
Frank Smith

Entering Organization
Shoreline Pediatrics

Vaccine Event information source (Administration Notes)
New immunization record (NIP001 00)

Value/Text for Vaccine Type
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0890-41)

Vaccine 2D Barcode

Date/Time of Start of Administration
Current Date

Administered Amount (of Vaccine)
0.25
Triggers Error that the administration amount is inconsistent with the vaccine administered (2014)
Administered Units (of Measure)
mL

Administering Provider
Sandra Molina

Administered-at Location
400 Shoreline Drive, Stamford Connecticut 06901

Lot Number
8L4B3521

Substance Expiration Date
12/31/2023

Substance Manufacturer Name
GlaxoSmithKline (SKB)

Completion Status
Completed (CP)

Route of Administration
Given by nose (NCIT C38284, HL70162 NS
Triggers Error that the administration route is inconsistent with the vaccine administered (2016)
Administration Site
Left Deltoid (HL70163 LD)

VFC Eligibility
Yes

Funding Source
Public

VIS Given Date
Current Date

VIS Fully Encoded Text-String
253088698300010311210806




Notes


The full vaccination details are provided here to facilitate the documentation constraints and/or screens that may be required by the vendor in order to attempt to document the data of interest, but these are not verified until the next step. Only those attributes specified that are anticipated to result in data quality alerts are required for this step.

While this test step requires verification of an appropriate route, the SUT should be sure that alternate route documentation is not restricted. While not part of this use case, there are situations where an alternate site may be medically indicated.


2.2.8. Record Influenza Vaccine administration

Test Step Type: SUT_MANUAL
The provider documents in the EHR all attributes associated with the new vaccine administration.

Test Story

Description

The nurse administers the inactivated influenza vaccine:

- Documents all required information for the vaccine.





Comments

No Comments


Pre-condition

Order is placed for inactivated influenza vaccine.


Post-Condition

The inactivated influenza vaccinations is recorded in the EHR.



Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type,  lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assures dose is appropriate for the vaccine).

Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The National Drug Code and manufacturer data elements (NDC) is embedded in the Global Trade Item Number (GTIN). Using mapping tables, the manufacturer can be determined from the NDC Code. The NDC and manufacturer data elements are later transmitted to an IIS by cross walking/mapping from the GTIN. The software system records this information as structured data elements.


Evaluation Criteria

The tester Verifies that there is a choice for VFC stock as she is VFC Eligible. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

The EHR records the following vaccine administration information, and using the 2D Bar code found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:


Entered BY
Sandra Molina
Ordering Provider
Frank Smith
Entering Organization
Shoreline Pediatrics
Vaccine Event information source (Administration Notes)
New immunization record (NIP001 00)
Value/Text for Vaccine Type
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0890-41)
Vaccine 2D Barcode
Date/Time of Start of Administration
Current Date
Administered Amount (of Vaccine)
0.5
Administered Units (of Measure)
mL
Administering Provider
Sandra Molina
Administered-at Location
400 Shoreline Drive, Stamford Connecticut 06901
Lot Number
8L4B3521
Substance Expiration Date
12/31/2023
Substance Manufacturer Name
GlaxoSmithKline (SKB)
Completion Status
Completed (CP)
Route of Administration
Intramuscular (NCIT C28161, HL70162 IM)
Administration Site
Left Deltoid (HL70163 LD)
VFC Eligibility
Yes
Funding Source
Public
VIS Given Date
Current Date
VIS Fully Encoded Text-String
253088698300010311210806

Notes

The EHR does not need to specify a 'new immunization', as long as there is a way to indicate that it is a new immunization within the EHR, this is acceptable (e.g. the default interpretation of the data entry is that it is a new immunization and not historical).


2.3. Juana Mariana Vazquez Transmit Immunization Report

Send the Immunization Report to the Immunization Registry (VXU/Z22) for Juana Mariana Vazquez.

Test Story

Description

Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EHR imported from the IIS.




Comments

The report must include all newly administered vaccines in any order. The report should also include the corrected information where the EHR has different information than the IIS and may also include the information imported from the IIS.


Pre-condition

The vaccines for the visit have been administered.


Post-Condition

The IIS has received the vaccine information (Z22 message).


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.

Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.

Note: Testing for NDC codes, CVX for immunizations.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

Sending information updated in the EHR back to the registry is an advanced function and some registries will not accept updates.


2.3.1. Transmit the immunization report to the Immunization Registry

Test Step Type: SUT_INITIATOR
The EHR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This includes all newly administered vaccines and may include historical information updated in the EHR during the visit.

Test Story

Description

Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EHR imported from the IIS.


Comments

The report must include all newly administered vaccines in any order. The report should also include the corrected information where the EHR has different information than the IIS and may also include the information imported from the IIS.


Pre-condition

The vaccines for the visit have been administered.


Post-Condition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.

Note: Testing for NDC codes, CVX for immunizations. 



Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.


Notes

Sending information updated in the EHR back to the registry is an advanced function and some registries will not accept updates.

The test data anticipates that the entire vaccine history is included in the message transmitted to the registry. Due to variation in practice, it is acceptable for the message to include only new vaccinations or only new vaccinations with updated content. The tester should document such instances, and may augment the submitted test message with such missing ‘history’ in order to run the test without error.

All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘).


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIPEHRFAC Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code XX Presence-Content Indifferent
MSH-22.10 Organization Identifier 100-1 Presence-Content Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIPIISFAC Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code XX Presence-Content Indifferent
MSH-23.10 Organization Identifier 100-2 Presence-Content Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Vazquez Value-Test Case Fixed
PID-5.2 Given Name Juana Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Mariana Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Acosta Value-Test Case Fixed
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 201711011105 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Value-Test Case Fixed
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford Value-Test Case Fixed
PID-11.4 State or Province CT Value-Test Case Fixed
PID-11.5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type L Value-Test Case Fixed
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13[1].4 Email Address
PID-13[1].6 Area/City Code 203 Value-Test Case Fixed
PID-13[1].7 Local Number 5551212 Value-Test Case Fixed
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type
PID-13[2].4 Email Address jmg@gmail.com Value-Test Case Fixed
PID-13[2].6 Area/City Code
PID-13[2].7 Local Number
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Value-Test Case Fixed
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator N Value-Test Case Fixed
PID-25 Birth Order
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/Recall - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20171101 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20171101 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20171101 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Vazquez Value-Test Case Fixed
NK1-2.2 Given Name Joanna Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Merida Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier GRP Value-Test Case Fixed
NK1-3.2 Text Grandparent Value-Test Case Fixed
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 4345 Standish Way
NK1-4.2 Other Designation
NK1-4.3 City Stamford Value-Test Case Fixed
NK1-4.4 State or Province CT Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 06903 Value-Test Case Fixed
NK1-4.6 Country
NK1-4.7 Address Type L
NK1-5[1] Phone Number
NK1-5[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5[1].4 Email Address
NK1-5[1].6 Area/City Code 203 Value-Test Case Fixed
NK1-5[1].7 Local Number 5551212 Value-Test Case Fixed
NK1-5[2] Phone Number
NK1-5[2].2 Telecommunication Use Code NET Value-Test Case Fixed
NK1-5[2].3 Telecommunication Equipment Type
NK1-5[2].4 Email Address jmg@gmail.com Value-Test Case Fixed
NK1-5[2].6 Area/City Code
NK1-5[2].7 Local Number

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Sirtis Presence-Content Indifferent
ORC-10.3 Given Name Lisa Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Carter
ORC-12.3 Given Name Jane
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SH Presence-Content Indifferent
ORC-17.2 Text Shoreline Hospital Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Presence-Content Indifferent
ORC-12.3 Given Name Frank Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Ricci
ORC-12.3 Given Name Gina
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Presence-Content Indifferent
ORC-12.3 Given Name Frank Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20171101 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Carter Presence-Content Indifferent
RXA-10.3 Given Name Jane
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code L
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6332FK33
RXA-16 Substance Expiration Date
RXA-16.1 Time 20171214
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20171220 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Presence-Content Indifferent
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6352FK1 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20171231 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Biologicals SA Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180520 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6352FK24
RXA-16 Substance Expiration Date
RXA-16.1 Time 20190831
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D409QS2341
RXA-16 Substance Expiration Date
RXA-16.1 Time 20181130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180323 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D409QS2433
RXA-16 Substance Expiration Date
RXA-16.1 Time 20180904
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180522 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D409QS3255
RXA-16 Substance Expiration Date
RXA-16.1 Time 20181201
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20190221 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D409QS249
RXA-16 Substance Expiration Date
RXA-16.1 Time 20190301
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20211120 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 02 Value-Test Case Fixed
RXA-9.2 Text Historical information - from other provider Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Casera Presence-Content Indifferent
RXA-10.3 Given Name Linda
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D643QS8243 Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20211201 Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Indifferent
RXA-17.2 Text Sanofi Pasteur Inc Indifferent
RXA-17.3 Name of Coding System MVX Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 7M54K9245
RXA-16 Substance Expiration Date
RXA-16.1 Time 20180324
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180323 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 7M55K3342
RXA-16 Substance Expiration Date
RXA-16.1 Time 20181030
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180522 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 7M75K4566
RXA-16 Substance Expiration Date
RXA-16.1 Time 20180523
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20181121 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 7M53K5534
RXA-16 Substance Expiration Date
RXA-16.1 Time 20190222
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text poliovirus vaccine, inactivated Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D333PV2431
RXA-16 Substance Expiration Date
RXA-16.1 Time 20181004
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180323 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text poliovirus vaccine, inactivated Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D333PV4344
RXA-16 Substance Expiration Date
RXA-16.1 Time 20190323
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20190221 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text poliovirus vaccine, inactivated Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 02 Value-Test Case Fixed
RXA-9.2 Text Historical information - from other provider Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Casera Presence-Content Indifferent
RXA-10.3 Given Name Linda
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D335PV9644
RXA-16 Substance Expiration Date
RXA-16.1 Time 20190422
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text poliovirus vaccine, inactivated Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier 00 Value-Test Case Fixed
RXA-18.2 Text Parental decision Presence-Content Indifferent
RXA-18.3 Name of Coding System NIP002 Value-Test Case Fixed
RXA-20 Completion Status RE Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number P243V3281
RXA-16 Substance Expiration Date
RXA-16.1 Time 20180130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180323 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number P343V8321
RXA-16 Substance Expiration Date
RXA-16.1 Time 20180330
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180522 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number P853V2164
RXA-16 Substance Expiration Date
RXA-16.1 Time 20180830
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20190111 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number P853V58532
RXA-16 Substance Expiration Date
RXA-16.1 Time 20190418
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180122 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 119 Value-Test Case Fixed
RXA-5.2 Text rotavirus, live, monovalent vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 1.0
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6359RV533
RXA-16 Substance Expiration Date
RXA-16.1 Time 20180215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180323 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 119 Value-Test Case Fixed
RXA-5.2 Text rotavirus, live, monovalent vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 1.0
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6359RV932
RXA-16 Substance Expiration Date
RXA-16.1 Time 20180510
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180925 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 150 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D8043IN8734
RXA-16 Substance Expiration Date
RXA-16.1 Time 20190725
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20181029 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 150 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D8043IN8746
RXA-16 Substance Expiration Date
RXA-16.1 Time 20190312
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20191002 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 150 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D9334IN9333
RXA-16 Substance Expiration Date
RXA-16.1 Time 20200522
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20201104 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 150 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D9553IN2243
RXA-16 Substance Expiration Date
RXA-16.1 Time 20210430
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20211015 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 150 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 03 Value-Test Case Fixed
RXA-9.2 Text Historical information - from parent's written record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Ricci Presence-Content Indifferent
RXA-10.3 Given Name Gina
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 8L4B3423 Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20211230 Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Indifferent
RXA-17.2 Text GlaxoSmithKline Indifferent
RXA-17.3 Name of Coding System MVX Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 150 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Value-Test Case Fixed
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Presence-Content Indifferent
RXA-10.3 Given Name Sandra Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 8L4B3521 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20231231 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20181123 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 83 Value-Test Case Fixed
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6359RT33
RXA-16 Substance Expiration Date
RXA-16.1 Time 20190104
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20190523 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 83 Value-Test Case Fixed
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6359RT48
RXA-16 Substance Expiration Date
RXA-16.1 Time 20190911
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180822 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 03 Value-Test Case Fixed
RXA-5.2 Text measles, mumps, rubella virus vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text Historical information - source unspecified Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Presence-Content Indifferent
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 0853CC
RXA-16 Substance Expiration Date
RXA-16.1 Time 20181215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210922 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 03 Value-Test Case Fixed
RXA-5.2 Text measles, mumps, rubella virus vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 0854FF
RXA-16 Substance Expiration Date
RXA-16.1 Time 20220413
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221015 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 03 Value-Test Case Fixed
RXA-5.2 Text measles, mumps, rubella virus vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 03 Value-Test Case Fixed
RXA-9.2 Text Historical information - from parent's written record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Presence-Content Indifferent
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 0934GG
RXA-16 Substance Expiration Date
RXA-16.1 Time 20231231
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20191215 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 21 Value-Test Case Fixed
RXA-5.2 Text varicella virus vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text Historical information - from public agency Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 2341BB
RXA-16 Substance Expiration Date
RXA-16.1 Time 20201201
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Indifferent
RXR-1.2 Text Intramuscular Indifferent
RXR-1.3 Name of Coding System NCIT Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier LT Value-Test Case Fixed
RXR-2.2 Text Left Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288
RXR-1.2 Text Oral
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288
RXR-1.2 Text Oral
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Indifferent
RXR-1.2 Text Intramuscular Indifferent
RXR-1.3 Name of Coding System NCIT Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RA
RXR-2.2 Text Right Arm
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document Type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300005911160720
OBX-5.2 Text Hepatitis B Vaccine VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171220
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS Presentation Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20171220
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171220
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7
OBX-3.2 Text vaccine fund pgm elig cat
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier V02
OBX-5.2 Text VFC eligible-Medicaid/Medicaid Managed Care
OBX-5.3 Name of Coding System HL70064
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171220
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3
OBX-3.2 Text Vaccine funding source
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier VXC50
OBX-5.2 Text Public
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20171220
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Indifferent
OBX-3.2 Text Document Type Indifferent
OBX-3.3 Name of Coding System LN Indifferent
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300010311210806 Indifferent
OBX-5.2 Text Influenza Vaccine - Inactivated VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text VIS Presentation Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier V02 Value-Test Case Fixed
OBX-5.2 Text VFC eligible-Medicaid/Medicaid Managed Care Presence-Content Indifferent
OBX-5.3 Name of Coding System HL70064 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3
OBX-3.2 Text Vaccine funding source
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier VXC50
OBX-5.2 Text Public
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juana Mariana Vazquez
Mother's Maiden Name Maria Acosta
ID Number 123456 987633
Date/Time of Birth 11/01/2017 11:05
Administrative Sex Female
Patient Address 4345 Standish Way Stamford CT 06903 USA
Local Number (203)555-1212
Email jmg@gmail.com
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator No
Birth Order
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 11/01/2017
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 11/01/2017
Protection Indicator No
Protection Indicator Effective Date 11/01/2017
Guardian or Responsible Party
Element Data
Name Joanna Merida Vazquez
Relationship Grandparent
Address 4345 Standish Way Stamford CT 06903
Phone Number (203)555-1212
Phone Number

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 11/01/2017
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider Jane Carter
Substance Lot Number 6332FK33
Substance Expiration Date 12/14/2017
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Vaccine Administration Information
Element Data
Administered Vaccine hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 12/20/2017
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 6352FK1
Substance Expiration Date 12/31/2017
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Document Type Hepatitis B Vaccine VIS
VIS Presentation Date 12/20/2017
vaccine fund pgm elig cat VFC eligible-Medicaid/Medicaid Managed Care
Vaccine funding source Public

Vaccine Administration Information
Element Data
Administered Vaccine hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 05/20/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6352FK24
Substance Expiration Date 08/31/2019
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Date/Time Start of Administration 01/22/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2341
Substance Expiration Date 11/30/2018
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 03/23/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2433
Substance Expiration Date 09/04/2018
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 05/22/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS3255
Substance Expiration Date 12/01/2018
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 02/21/2019
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS249
Substance Expiration Date 03/01/2019
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 11/20/2021
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D643QS8243
Substance Expiration Date 12/01/2021
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 01/22/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M54K9245
Substance Expiration Date 03/24/2018
Substance Manufacturer Name Merck and Co Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 03/23/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M55K3342
Substance Expiration Date 10/30/2018
Substance Manufacturer Name Merck and Co Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 05/22/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M75K4566
Substance Expiration Date 05/23/2018
Substance Manufacturer Name Merck and Co Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 11/21/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M53K5534
Substance Expiration Date 02/22/2019
Substance Manufacturer Name Merck and Co Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine poliovirus vaccine, inactivated
Date/Time Start of Administration 01/22/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV2431
Substance Expiration Date 10/04/2018
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Arm
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine poliovirus vaccine, inactivated
Date/Time Start of Administration 03/23/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV4344
Substance Expiration Date 03/23/2019
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Arm
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine poliovirus vaccine, inactivated
Date/Time Start of Administration 02/21/2019
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D335PV9644
Substance Expiration Date 04/22/2019
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Arm
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine poliovirus vaccine, inactivated
Date/Time Start of Administration 10/31/2022
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental decision
Completion Status Refused
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Vaccine pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 01/22/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P243V3281
Substance Expiration Date 01/30/2018
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 03/23/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P343V8321
Substance Expiration Date 03/30/2018
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 05/22/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V2164
Substance Expiration Date 08/30/2018
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 01/11/2019
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V58532
Substance Expiration Date 04/18/2019
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine rotavirus, live, monovalent vaccine
Date/Time Start of Administration 01/22/2018
Administered Amount 1.0
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV533
Substance Expiration Date 02/15/2018
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Oral
Administration Site
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine rotavirus, live, monovalent vaccine
Date/Time Start of Administration 03/23/2018
Administered Amount 1.0
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV932
Substance Expiration Date 05/10/2018
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Oral
Administration Site
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable, quadrivalent, preservative free
Date/Time Start of Administration 09/25/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 07/25/2019
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable, quadrivalent, preservative free
Date/Time Start of Administration 10/29/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8746
Substance Expiration Date 03/12/2019
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable, quadrivalent, preservative free
Date/Time Start of Administration 10/02/2019
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9334IN9333
Substance Expiration Date 05/22/2020
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable, quadrivalent, preservative free
Date/Time Start of Administration 11/04/2020
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9553IN2243
Substance Expiration Date 04/30/2021
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable, quadrivalent, preservative free
Date/Time Start of Administration 10/15/2021
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from parent's written record
Administering Provider Gina Ricci
Substance Lot Number 8L4B3423
Substance Expiration Date 12/30/2021
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Gina Ricci

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable, quadrivalent, preservative free
Date/Time Start of Administration 10/31/2022
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 8L4B3521
Substance Expiration Date 12/31/2023
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Document Type Influenza Vaccine - Inactivated VIS
VIS Presentation Date 10/31/2022
vaccine fund pgm elig cat VFC eligible-Medicaid/Medicaid Managed Care
Vaccine funding source Public

Vaccine Administration Information
Element Data
Administered Vaccine hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 11/23/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT33
Substance Expiration Date 01/04/2019
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Right Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 05/23/2019
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT48
Substance Expiration Date 09/11/2019
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine measles, mumps, rubella virus vaccine
Date/Time Start of Administration 08/22/2018
Administered Amount 0.5
Administered Units
Administration Notes Historical information - source unspecified
Administering Provider Sandra Molina
Substance Lot Number 0853CC
Substance Expiration Date 12/15/2018
Substance Manufacturer Name Merck and Co Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Thigh
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Vaccine measles, mumps, rubella virus vaccine
Date/Time Start of Administration 09/22/2021
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 0854FF
Substance Expiration Date 04/13/2022
Substance Manufacturer Name Merck and Co Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Arm
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Vaccine measles, mumps, rubella virus vaccine
Date/Time Start of Administration 10/15/2022
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from parent's written record
Administering Provider Sandra Molina
Substance Lot Number 0934GG
Substance Expiration Date 12/31/2023
Substance Manufacturer Name Merck and Co Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Arm
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Vaccine varicella virus vaccine
Date/Time Start of Administration 12/15/2019
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 2341BB
Substance Expiration Date 12/01/2020
Substance Manufacturer Name Merck and Co Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Right Arm
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

2.3.2. Receive ACK Z23 from Immunization Registry for Updated Vaccination

Test Step Type: TA_RESPONDER
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the updated message.

Test Story

Description

The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the update message.


Comments

No Comments


Pre-condition

A VXU message is generated by the EHR.


Post-Condition

The ACK Z23 is received by the EHR.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.


Evaluation Criteria

The acknowledgement message is consumed by the system responsible for the content of the administration message without error. This is not typically part of the user interface, so this may be demonstrated through back-end evidence.


Notes

Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031073734.034-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-1.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-AD-1.1_Send_V04_Z22

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

2.3.3. Record an adverse reaction

Test Step Type: SUT_MANUAL
The Provider records in the EHR an adverse reaction of rash within 14 days of dose.

Test Story

Description

Following the vaccine administration, the mother reports that the patient had a rash within 14 days of dose.


Comments

No Comments


Pre-condition

The vaccinations for the visit have been administered.


Post-Condition

The adverse reaction to the Influenza vaccination of rash within 14 days of dose is recorded in the EHR.


Test Objectives

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.


Evaluation Criteria

Verify that vendor can record the adverse reaction to the Influenza vaccination of rash within 14 days of dose correctly and without omission (VXC14). The coded value is not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions.

If the vendor is unable to record the concept (VXC14) using the CDCPHINVS coding system, the vendor may specify the reaction using SNOMED-CT or Narrative Text. This should be recorded as passing, but with a notable exception documented.


Notes

Adverse Reactions may be documented with SNOMED-CT or as a narrative note. These two approaches may be considered passing with notable exception. The approach that is used instead of the value set PHVS_VaccinationReaction_IIS 2.16.840.1.114222.4.11.3289 should be documented in the tester notes.

The test data anticipates that the entire vaccine history is included in the message transmitted to the registry. Due to variation in practice, it is acceptable for the message to include only the record with the adverse reaction. The tester should document such instances and may augment the submitted test message with such missing ‘history’ in order to run the test without error.


2.3.4. Updates Vaccination Information and Transmits Updated Vaccination Report

Test Step Type: SUT_INITIATOR
This test step updates a vaccination administered with a correction to the body site of administration.

Test Story

Description

After administering a seasonal influenza vaccination, Sandra Molina, the nurse recording the administration information realize she made a mistake in documenting the body site where the vaccine was administered. The vaccination was accidentally recorded as being given in the left deltoid HL7 Table 0163 RD). However, it was actually administered into the patient’s right deltoid (HL7 Table 0163 RD) because the patient had a shoulder spica cast on her left side.


Comments

No Comments


Pre-condition

The Influenza vaccination has been documented in the EMR or other clinical software system with the incorrect body site for the dose given, left deltoid HL7 Table 0163 RD)


Post-Condition

The vaccination records has been transmitted to the IIS with the corrected body site for the Influenza dose, right deltoid (HL7 Table 0163 RD).


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

Support for update functionality

Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.

Note: Testing for NDC codes, CVX for immunizations.



Evaluation Criteria

The chart is updated to reflect the vaccine  was administered into the right deltoid.  

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. 

Entered By
Sandra Molina
Ordering Provider
Frank Smith
Entering Organization
Shoreline Pediatrics
Vaccine Event information source (Administration Notes)
New immunization record (NIP001 00)
Value/Text for Vaccine Type
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0890-41)
Vaccine 2D Barcode
Date/Time of Start of Administration
Current Date
Administered Amount (of Vaccine)
0.5
Administered Units (of Measure)
mL
Administering Provider
Sandra Molina
Administered-at Location
400 Shoreline Drive, Stamford Connecticut 06901
Lot Number
8L4B3521
Substance Expiration Date
12/31/2023
Substance Manufacturer Name
GlaxoSmithKline (SKB)
Completion Status
Completed (CP)
Route of Administration
Intramuscular (NCIT C28161, HL70162 IM)
Administration Site
Right Deltoid (HL70163 RD)
VFC Eligibility
Yes
Funding Source
Public
VIS Given Date
Current Date
VIS Fully Encoded Text-String
253088698300010311210806

Notes

None


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIPEHRFAC
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-1
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIPIISFAC
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-2

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Vazquez Value-Test Case Fixed
PID-5.2 Given Name Juana Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Mariana Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Acosta Value-Test Case Fixed
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 201711011105 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford Value-Test Case Fixed
PID-11.4 State or Province CT Value-Test Case Fixed
PID-11.5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type L Value-Test Case Fixed
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13[1].4 Email Address
PID-13[1].6 Area/City Code 203 Value-Test Case Fixed
PID-13[1].7 Local Number 5551212 Value-Test Case Fixed
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type
PID-13[2].4 Email Address jmg@gmail.com Value-Test Case Fixed List
PID-13[2].6 Area/City Code
PID-13[2].7 Local Number
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator N Value-Test Case Fixed
PID-25 Birth Order
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/Recall - any method
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20171101 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20171101 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20171101 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Vazquez Value-Test Case Fixed
NK1-2.2 Given Name Joanna Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Merida Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier GRP Value-Test Case Fixed
NK1-3.2 Text Grandparent
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 4345 Standish Way
NK1-4.2 Other Designation
NK1-4.3 City Stamford Value-Test Case Fixed
NK1-4.4 State or Province CT Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 06903 Value-Test Case Fixed
NK1-4.6 Country
NK1-4.7 Address Type L Value-Test Case Fixed
NK1-5[1] Phone Number
NK1-5[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5[1].4 Email Address
NK1-5[1].6 Area/City Code 203 Value-Test Case Fixed
NK1-5[1].7 Local Number 5551212 Value-Test Case Fixed
NK1-5[2] Phone Number
NK1-5[2].2 Telecommunication Use Code NET Value-Test Case Fixed
NK1-5[2].3 Telecommunication Equipment Type
NK1-5[2].4 Email Address jmg@gmail.com Value-Test Case Fixed
NK1-5[2].6 Area/City Code
NK1-5[2].7 Local Number

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Value-Test Case Fixed
ORC-10.3 Given Name Sandra Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Value-Test Case Fixed
ORC-12.3 Given Name Frank Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Value-Test Case Fixed
ORC-17.2 Text Shoreline Pediatrics Value-Test Case Fixed
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 150 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Value-Test Case Fixed
RXA-10.3 Given Name Sandra Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 8L4B3521 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20231231 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA U Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier RD Value-Test Case Fixed
RXR-2.2 Text Right Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document Type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300010311210806
OBX-5.2 Text Influenza Vaccine - Inactivated VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS Presentation Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7
OBX-3.2 Text vaccine fund pgm elig cat
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier V02
OBX-5.2 Text VFC eligible-Medicaid/Medicaid Managed Care
OBX-5.3 Name of Coding System HL70064
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3
OBX-3.2 Text Vaccine funding source
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier VXC50
OBX-5.2 Text Public
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

2.3.5. Receive ACK Z23 from Immunization Registry - For Update Message

Test Step Type: TA_RESPONDER
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Test Story

Description

The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.


Comments

No Comments


Pre-condition

A VXU message is generated by the EHR.


Post-Condition

The ACK Z23 is received by the EHR.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.


Evaluation Criteria

The acknowledgement message is consumed by the system responsible for the content of the administration message without error. This is not typically part of the user interface, so this may be demonstrated through back-end evidence.


Notes

Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031082240-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-1.3_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-001.00

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

2.4. Juana Mariana Vazquez Display Immunization Report

Produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.).

Test Story

Description

Following the vaccination visit, the provider uses the EHR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.).


Comments

No Comments


Pre-condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. New vaccinations have been administered.


Post-Condition

The patient/parent has been provided a patient immunization history report.


Test Objectives

Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

 

Produce Immunization Forecast Report: The EHR or other clinical software system creates a list of immunizations to be administered within a specified time frame.



Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


2.4.1. Produce an immunization report for Juana Mariana Vazquez including all history

Test Step Type: SUT_MANUAL
The EHR is used to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.).

Test Story

Description

Following the vaccination visit, the provider uses the EHR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.).


Comments

No Comments


Pre-condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. New vaccinations have been administered.


Post-Condition

The patient/parent has been provided a patient immunization history report.


Test Objectives

Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

 

Produce Immunization Forecast Report: The EHR or other clinical software system creates a list of immunizations to be administered within a specified time frame.


Evaluation Criteria

The following patient demographics are displayed:


Patient Identifier Number:
Vendor Assigned
Patient Identifier Type Code:
Vendor Assigned
Patient Name:
Juana Mariana Vazquez
Date/Time of Birth:
11/01/2017 11:05am
Sex:
Female
Patient Address:
4345 Standish Way, Stamford, CT, 06903
Multiple Birth Indicator:
No
Birth Order:
N/A


The following Vaccination History is displayed:

Vaccine Group:
Hep B Peds NOS
Administered:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) ENGERIX-B (NDC 58160-0820-43)
Date Administered:
11/01/2017
Additional Observations:
None
Dose #:
1
Doses in Series:
3
Valid Dose:
Y
Ordering Provider:
Jane Carter
Entered By:
Lisa Sirtis
Entering Organization:
Shoreline Hospital
Administered Amt:
0.5 mL
Administering Provider:
Jane Carter
Administered at Location:
325 Shoreline Drive, Stamford Connecticut 06901
Lot#:
6332FK33
Exp Date:
12/14/2017
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
Hep B Peds NOS
Administered:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) ENGERIX-B (NDC 58160-0820-43)
Date Administered:
12/20/2017
Additional Observations:
None
Dose #:
2
Doses in Series:
3
Valid Dose:
Y
Ordering Provider:
Frank Smith
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Sandra Molina
Administered at Location:
400 Shoreline Drive, Stamford Connecticut 06901
Lot#:
6352FK1
Exp Date:
12/31/2017
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
Hep B Peds NOS
Administered:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) ENGERIX-B (NDC 58160-0820-43)
Date Administered:
05/20/2018
Additional Observations:
None
Dose #:
3
Doses in Series:
3
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
6352FK24
Exp Date:
08/31/2019
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163 : LT)
Vaccine Group:
diphtheria, tetanus toxoids and acellular pertussis vaccine
Administered:
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) DAPTACEL (NDC 49281-0286-58)
Date Administered:
1/22/2018
Additional Observations:
None
Dose #:
1
Doses in Series:
5
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D409QS2341
Exp Date:
11/30/2018
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
diphtheria, tetanus toxoids and acellular pertussis vaccine
Administered:
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) DAPTACEL (NDC 49281-0286-58)
Date Administered:
3/23/2018
Additional Observations:
None
Dose #:
2
Doses in Series:
5
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D409QS2433
Exp Date:
9/4/2018
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Thigh (HL70163: RT)
Vaccine Group:
diphtheria, tetanus toxoids and acellular pertussis vaccine
Administered:
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) DAPTACEL (NDC 49281-0286-58)
Date Administered:
5/22/2018
Additional Observations:
None
Dose #:
3
Doses in Series:
5
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D409QS3255
Exp Date:
12/1/2018
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
diphtheria, tetanus toxoids and acellular pertussis vaccine
Administered:
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) DAPTACEL (NDC 49281-0286-58)
Date Administered:
2/21/2019
Additional Observations:
None
Dose #:
4
Doses in Series:
5
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D409QS249
Exp Date:
3/1/2019
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
diphtheria, tetanus toxoids and acellular pertussis vaccine
Administered:
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) DAPTACEL (NDC 49281-0286-58)
Date Administered:
11/20/2021
Additional Observations:
None
Dose #:
5
Doses in Series:
5
Valid Dose:
Y
Ordering Provider:
J. Rodriguez
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Linda Casera
Administered at Location:
4253 Standish Way, Stamford Connecticut 06903
Lot#:
D643QS8243
Exp Date:
12/01/2021
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
Hib
Administered:
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) PedvaxHIB (NDC 00006-4897-01)
Date Administered:
1/22/2018
Additional Observations:
None
Dose #:
1
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
7M54K9245
Exp Date:
3/24/2018
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Thigh (HL70163: RT)
Vaccine Group:
Hib
Administered:
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) PedvaxHIB (NDC 00006-4897-01)
Date Administered:
3/23/2018
Additional Observations:
None
Dose #:
2
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
7M55K3342
Exp Date:
10/30/2018
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
Hib
Administered:
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) PedvaxHIB (NDC 00006-4897-01)
Date Administered:
5/22/2018
Additional Observations:

Dose #:
3
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
7M75K4566
Exp Date:
5/23/2018
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Thigh (HL70163: RT)
Vaccine Group:
Hib
Administered:
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) PedvaxHIB (NDC 00006-4897-01)
Date Administered:
11/21/2018
Additional Observations:

Dose #:
4
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
7M53K5534
Exp Date:
2/22/2019
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
poliovirus vaccine, inactivated
Administered:
poliovirus vaccine, inactivated (CVX 10) IPOL (NDC 49281-0860-88)
Date Administered:
1/22/2018
Additional Observations:

Dose #:
1
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D333PV2431
Exp Date:
10/4/2018
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Arm (HL70163: LA)
Vaccine Group:
poliovirus vaccine, inactivated
Administered:
poliovirus vaccine, inactivated (CVX 10) IPOL (NDC 49281-0860-88)
Date Administered:
3/23/2018
Additional Observations:
None
Dose #:
2
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D333PV4344
Exp Date:
3/23/2019
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Arm (HL70163: LA)
Vaccine Group:
poliovirus vaccine, inactivated
Administered:
poliovirus vaccine, inactivated (CVX 10) IPOL (NDC 49281-0860-88)
Date Administered:
2/21/2019
Additional Observations:
Adverse Reaction of (VXC12^fever of >40.5C (105F) within 48 hours of dose^CDCPHINVS)
Dose #:
3
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
J. Rodriguez
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Linda Casera
Administered at Location:
4253 Standish Way, Stamford Connecticut 06903
Lot#:
D335PV9644
Exp Date:
4/22/2019
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Arm (HL70163: LA)
Vaccine Group:
pneumococcal
Administered:
pneumococcal conjugate vaccine, 13 valent (CVX 133) PREVNAR 13 (NDC 00005-1971-01)
Date Administered:
1/22/2018
Additional Observations:

Dose #:
1
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
P243V3281
Exp Date:
1/30/2018
Manufacturer:
Pfizer, Inc (MVX PFR)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
pneumococcal
Administered:
pneumococcal conjugate vaccine, 13 valent (CVX 133) PREVNAR 13 (NDC 00005-1971-01)
Date Administered:
3/23/2018
Additional Observations:

Dose #:
2
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
P343V8321
Exp Date:
3/30/2018
Manufacturer:
Pfizer, Inc (MVX PFR)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
pneumococcal
Administered:
pneumococcal conjugate vaccine, 13 valent (CVX 133) PREVNAR 13 (NDC 00005-1971-01)
Date Administered:
5/22/2018
Additional Observations:

Dose #:
3
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
P853V2164
Exp Date:
8/30/2018
Manufacturer:
Pfizer, Inc (MVX PFR)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Thigh (HL70163: LT)
Vaccine Group:
pneumococcal
Administered:
pneumococcal conjugate vaccine, 13 valent (CVX 133) PREVNAR 13 (NDC 00005-1971-01)
Date Administered:
1/11/2019
Additional Observations:

Dose #:
4
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
P853V58532
Exp Date:
4/18/2019
Manufacturer:
Pfizer, Inc (MVX PFR)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
Rotavirus
Administered:
rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0851-01)
Date Administered:
1/22/2018
Additional Observations:

Dose #:
1
Doses in Series:
3
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
1 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
6359RV533
Exp Date:
2/15/2018
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Oral (NCIT: C38288, HL70162 : PO)
Site:
(N/A)
Vaccine Group:
Rotavirus
Administered:
rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0851-01)
Date Administered:
3/23/2018
Additional Observations:

Dose #:
2
Doses in Series:
3
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
1 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
6359RV932
Exp Date:
5/10/2018
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Oral (NCIT: C38288, HL70162 : PO)
Site:
(N/A)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0898-41)
Date Administered:
9/25/2018
Additional Observations:

Dose #:
1
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D8043IN8734
Exp Date:
7/25/2019
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0898-41)
Date Administered:
10/29/2018
Additional Observations:

Dose #:
2
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D8043IN8746
Exp Date:
3/12/2019
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Thigh (HL70163: RT)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0896-41)
Date Administered:
10/02/2019
Additional Observations:

Dose #:

Doses in Series:

Valid Dose:

Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D9334IN9333
Exp Date:
5/22/2020
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0885-41)
Date Administered:
11/4/2020
Additional Observations:

Dose #:

Doses in Series:

Valid Dose:

Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D9553IN2243
Exp Date:
4/30/2021
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0887-41)
Date Administered:
10/15/2021
Additional Observations:

Dose #:

Doses in Series:

Valid Dose:

Ordering Provider:
Gina Ricci
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Gina Ricci
Administered at Location:
Oceanview Pharmacy, 15 Post Road, Stamford Connecticut 06901
Lot#:
8L4B3423
Exp Date:
12/30/2021
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0890-41)
Date Administered:
Current Date
Additional Observations:
Adverse Reaction of (VXC14^Rash within 14 days of dose ^CDCPHINVS)
Dose #:

Doses in Series:

Valid Dose:

Ordering Provider:
Frank Smith
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Sandra Molina
Administered at Location:
400 Shoreline Drive, Stamford Connecticut 06901
Lot#:
8L4B3521
Exp Date:
12/31/2023
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Deltoid (HL70163: RD)
Vaccine Group:
Hep A
Administered:
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) HAVRIX (NDC 58160-0825-43)
Date Administered:
11/23/2018
Additional Observations:

Dose #:
1
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
6359RT33
Exp Date:
1/4/2019
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Deltoid (HL70163: RD)
Vaccine Group:
Hep A
Administered:
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) HAVRIX (NDC 58160-0825-43)
Date Administered:
5/23/2019
Additional Observations:

Dose #:
2
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
6359RT48
Exp Date:
9/11/2019
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
MMR
Administered:
measles, mumps, rubella virus vaccine (CVX 03) MMR II (NDC 00006-4681-01)
Date Administered:
08/22/2018
Additional Observations:
Invalid because it was given too soon
Dose #:

Doses in Series:
2
Valid Dose:
N
Ordering Provider:
Frank Smith
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Sandra Molina
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
0853CC
Exp Date:
12/15/2018
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
MMR
Administered:
measles, mumps, rubella virus vaccine (CVX 03) MMR II (NDC 00006-4681-01)
Date Administered:
9/22/2021
Additional Observations:

Dose #:
1
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
0854FF
Exp Date:
4/13/2022
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Arm (HL70163: LA)
Vaccine Group:
MMR
Administered:
measles, mumps, rubella virus vaccine (CVX 03) MMR II (NDC 00006-4681-01)
Date Administered:
14 days PRIOR to day of TEST
Additional Observations:

Dose #:
2
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Frank Smith
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Sandra Molina
Administered at Location:
400 Shoreline Drive, Stamford Connecticut 06901
Lot#:
0934GG
Exp Date:
12/31/2023
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Arm (HL70163: LA)
Vaccine Group:
Varicella
Administered:
Varicella vaccine (CVX 21) Varivax (NDC 00006-4827-01)
Date Administered:
12/15/2019
Additional Observations:

Dose #:
1
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
 Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
2341BB
Exp Date:
12/1/2020
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Right Arm (HL70163: RA)
Vaccine Group:
IPV
Due Date:
10/31/2021
Earliest Date to Give:
10/31/2021
Overdue Date:
10/31/2023
Immunization Schedule:
ACIP
Vaccine Group:
Varicella
Due Date:
10/31/2021
Earliest Date to Give:
10/31/2021
Overdue Date:
10/31/2023
Immunization Schedule:
ACIP

Notes

The immunization report may provide a subset of demographic information sufficient to identify the patient. Any demographic information included should be evaluated against the listed demographic information for accuracy.

The immunization report does not need to display all of the information listed in the evaluation criteria for each vaccination, but they do need to produce the complete list of vaccines given and the date.

The tester is requested to document separately the success or failure of the Immunization History and the Immunization forecast as these two requirements are tested concurrently.

Influenza vaccine should be due between September and October of the flue season, which may show as the prior year to testing or the year of testing.


2.5. Juana Mariana Vazquez Provide Patient Access to Immunization Report

Provide patient access to the immunization record for the patient including all history and forecast information. The report can be provided in various formats, including view, and print. The patient is also able to access the Vaccine Information Statements.

Test Story

Description

Following the vaccination visit, the provider uses the EHR to produce an immunization report that can be accessed by the patient including all history and forecast information. The report can be provided in various formats, including view, and print. The patient is also able to access the Vaccine Information Statements.  


Comments

No Comments


Pre-condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. New vaccinations have been administered.


Post-Condition

The patient/parent has been provided access to a patient immunization history record.


Test Objectives

Provide Access to Patient Immunization Record: The EHR or other clinical software system provides patients and their authorized representatives with electronic access to immunization records (either directly or by interacting with an external system such as a patient portal).

Provide Access to Recommendations and Vaccine Information Statement(s): The immunization record displays immunization recommendations to be discussed with a provider, displaying the relevant Vaccine Information Statement.

Provide Access to Printable Immunization Record: The EHR or other clinical software system provides a printable version of the immunization record. 


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


2.5.1. Produce an immunization report for Juana Mariana Vazquez including all history

Test Step Type: SUT_MANUAL
The EHR is used to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.).

Test Story

Description

Following the vaccination visit, the patient/parent uses the specified interface to access the immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.).


Comments

No Comments


Pre-condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. New vaccinations have been administered. The parent/patient is provided with an account to access the immunization history.


Post-Condition

The patient/parent has been provided a patient immunization history report.


Test Objectives

Provide Access to Patient Immunization Record: The EHR or other clinical software system provides patients and their authorized representatives with electronic access to immunization records (either directly or by interacting with an external system such as a patient portal).

Provide Access to Recommendations and Vaccine Information Statement(s): The immunization record displays immunization recommendations to be discussed with a provider, displaying the relevant Vaccine Information Statement.


Evaluation Criteria

Using the patient facing features (e.g. portal), show that the vaccine history can be displayed including today’s vaccine/forecast:

The following patient demographics are displayed:


Patient Identifier Number:
Vendor Assigned
Patient Identifier Type Code:
Vendor Assigned
Patient Name:
Juana Mariana Vazquez
Date/Time of Birth:
11/01/2017 11:05am
Sex:
Female
Patient Address:
4345 Standish Way, Stamford, CT, 06903
Multiple Birth Indicator:
No
Birth Order:
N/A


The following Vaccination History is displayed:

Vaccine Group:
Hep B Peds NOS
Administered:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-43)
Date Administered:
11/01/2017
Additional Observations:
None
Dose #:
1
Doses in Series:
3
Valid Dose:
Y
Ordering Provider:
Jane Carter
Entered By:
Lisa Sirtis
Entering Organization:
Shoreline Hospital
Administered Amt:
0.5 mL
Administering Provider:
Jane Carter
Administered at Location:
325 Shoreline Drive, Stamford Connecticut 06901
Lot#:
6332FK33
Exp Date:
12/14/2017
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163:  LT)
Vaccine Group:
Hep B Peds NOS
Administered:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) ENGERIX-B (NDC 58160-0820-43)
Date Administered:
12/20/2017
Additional Observations:
None
Dose #:
2
Doses in Series:
3
Valid Dose:
Y
Ordering Provider:
Frank Smith
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Sandra Molina
Administered at Location:
400 Shoreline Drive, Stamford Connecticut 06901
Lot#:
6352FK1
Exp Date:
12/31/2017
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
Hep B Peds NOS
Administered:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) ENGERIX-B (NDC 58160-0820-43)
Date Administered:
05/20/2018
Additional Observations:
None
Dose #:
3
Doses in Series:
3
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Sandra Molina
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
6352FK24
Exp Date:
08/31/2019
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163:  LT)
Vaccine Group:
diphtheria, tetanus toxoids and acellular pertussis vaccine
Administered:
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) DAPTACEL (NDC 49281-0286-58)
Date Administered:
01/22/2018
Additional Observations:
None
Dose #:
1
Doses in Series:
5
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D409QS2341
Exp Date:
11/30/2018
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163:  LT)
Vaccine Group:
diphtheria, tetanus toxoids and acellular pertussis vaccine
Administered:
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) DAPTACEL (NDC 49281-0286-58)
Date Administered:
3/23/2018
Additional Observations:

Dose #:
2
Doses in Series:
5
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D409QS2433
Exp Date:
09/04/2018
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Thigh (HL70163:  RT)
Vaccine Group:
diphtheria, tetanus toxoids and acellular pertussis vaccine
Administered:
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) DAPTACEL (NDC 49281-0286-58)
Date Administered:
5/22/2018
Additional Observations:

Dose #:
3
Doses in Series:
5
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D409QS3255
Exp Date:
12/01/2018
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163:  LT)
Vaccine Group:
diphtheria, tetanus toxoids and acellular pertussis vaccine
Administered:
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) DAPTACEL (NDC 49281-0286-58)
Date Administered:
02/21/2019
Additional Observations:

Dose #:
4
Doses in Series:
5
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D409QS249
Exp Date:
03/01/2019
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163:  LD)
Vaccine Group:
diphtheria, tetanus toxoids and acellular pertussis vaccine
Administered:
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) DAPTACEL (NDC 49281-0286-58)
Date Administered:
11/20/2021
Additional Observations:

Dose #:
5
Doses in Series:
5
Valid Dose:
Y
Ordering Provider:
J. Rodriguez
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Linda Casera
Administered at Location:
4253 Standish Way, Stamford Connecticut 06903
Lot#:
D643QS8243
Exp Date:
12/01/2021
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163:  LD)
Vaccine Group:
Hib
Administered:
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) PedvaxHIB (NDC 00006-4897-01)
Date Administered:
01/22/2018
Additional Observations:

Dose #:
1
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
7M54K9245
Exp Date:
03/24/2018
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Thigh (HL70163:  RT)
Vaccine Group:
Hib
Administered:
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) PedvaxHIB (NDC 00006-4897-01)
Date Administered:
3/23/2018
Additional Observations:

Dose #:
2
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
7M55K3342
Exp Date:
10/30/2018
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163:  LT)
Vaccine Group:
Hib
Administered:
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) PedvaxHIB (NDC 00006-4897-01)
Date Administered:
05/22/2018
Additional Observations:

Dose #:
3
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
7M75K4566
Exp Date:
05/23/2018
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Thigh (HL70163:  RT)
Vaccine Group:
Hib
Administered:
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) PedvaxHIB (NDC 00006-4897-01)
Date Administered:
11/21/2018
Additional Observations:

Dose #:
4
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
7M53K5534
Exp Date:
02/22/2019
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163:  LD)
Vaccine Group:
poliovirus vaccine, inactivated
Administered:
poliovirus vaccine, inactivated (CVX 10) IPOL (NDC 49281-0860-88)
Date Administered:
01/22/2018
Additional Observations:

Dose #:
1
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D333PV2431
Exp Date:
10/04/2018
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Arm (HL70163:  LA)
Vaccine Group:
poliovirus vaccine, inactivated
Administered:
poliovirus vaccine, inactivated (CVX 10) IPOL (NDC 49281-0860-88)
Date Administered:
3/23/2018
Additional Observations:
None
Dose #:
2
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D333PV4344
Exp Date:
03/23/2019
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Arm (HL70163:  LA)
Vaccine Group:
poliovirus vaccine, inactivated
Administered:
poliovirus vaccine, inactivated (CVX 10) IPOL (NDC 49281-0860-88)
Date Administered:
02/21/2019
Additional Observations:
Adverse Reaction of (VXC12^fever of >40.5C (105F) within 48 hours of dose^CDCPHINVS)
Dose #:
3
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
J. Rodriguez
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Linda Casera
Administered at Location:
4253 Standish Way, Stamford Connecticut 06903
Lot#:
D335PV9644
Exp Date:
04/22/2019
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Arm (HL70163:  LA)
Vaccine Group:
pneumococcal
Administered:
pneumococcal conjugate vaccine, 13 valent (CVX 133) PREVNAR 13 (NDC 00005-1971-01)
Date Administered:
01/22/2018
Additional Observations:

Dose #:
1
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
P243V3281
Exp Date:
01/30/2018
Manufacturer:
Pfizer, Inc (MVX PFR)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163:  LT)
Vaccine Group:
pneumococcal
Administered:
pneumococcal conjugate vaccine, 13 valent (CVX 133) PREVNAR 13 (NDC 00005-1971-01)
Date Administered:
3/23/2018
Additional Observations:

Dose #:
2
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
P343V8321
Exp Date:
03/30/2018
Manufacturer:
Pfizer, Inc (MVX PFR)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163:  LT)
Vaccine Group:
pneumococcal
Administered:
pneumococcal conjugate vaccine, 13 valent (CVX 133) PREVNAR 13 (NDC 00005-1971-01)
Date Administered:
05/22/2018
Additional Observations:

Dose #:
3
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
P853V2164
Exp Date:
08/30/2018
Manufacturer:
Pfizer, Inc (MVX PFR)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Thigh (HL70163:  RT)
Vaccine Group:
pneumococcal
Administered:
pneumococcal conjugate vaccine, 13 valent (CVX 133) PREVNAR 13 (NDC 00005-1971-01)
Date Administered:
1/11/2019
Additional Observations:

Dose #:
4
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
P853V58532
Exp Date:
04/18/2019
Manufacturer:
Pfizer, Inc (MVX PFR)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163:  LD)
Vaccine Group:
Rotavirus
Administered:
rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0851-01)
Date Administered:
01/22/2018
Additional Observations:

Dose #:
1
Doses in Series:
3
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
1 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
6359RV533
Exp Date:
02/15/2018
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Oral (NCIT: C38288, HL70162 : PO)
Site:
(N/A)
Vaccine Group:
Rotavirus
Administered:
rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0851-01)
Date Administered:
03/23/2018
Additional Observations:

Dose #:
2
Doses in Series:
3
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
1 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
6359RV932
Exp Date:
05/10/2018
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Oral (NCIT: C38288, HL70162 : PO)
Site:
(N/A)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0898-41)
Date Administered:
9/25/2018
Additional Observations:

Dose #:
1
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D8043IN8734
Exp Date:
07/25/2019
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163:  LT)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0898-41)
Date Administered:
10/29/2018
Additional Observations:

Dose #:
2
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D8043IN8746
Exp Date:
03/12/2019
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Thigh (HL70163:  RT)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0896-41)
Date Administered:
10/02/2019
Additional Observations:

Dose #:

Doses in Series:

Valid Dose:

Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D9334IN9333
Exp Date:
05/22/2020
Manufacturer:
GlaxoSmithKline (MVX SKB)"
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163:  LD)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0885-41)
Date Administered:
11/04/2020
Additional Observations:

Dose #:

Doses in Series:

Valid Dose:

Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D9553IN2243
Exp Date:
04/30/2021
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163:  LD)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0887-41)
Date Administered:
10/15/2021
Additional Observations:

Dose #:

Doses in Series:

Valid Dose:

Ordering Provider:
Gina Ricci
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Gina Ricci
Administered at Location:
Oceanview Pharmacy, 15 Post Road, Stamford Connecticut 06901
Lot#:
8L4B3423|
Exp Date:
12/30/2021
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163:  LD)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0890-41)
Date Administered:
Current Date
Additional Observations:
Adverse Reaction of (VXC14^Rash within 14 days of dose ^CDCPHINVS)
Dose #:

Doses in Series:

Valid Dose:

Ordering Provider:
Frank Smith
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Sandra Molina
Administered at Location:
400 Shoreline Drive, Stamford Connecticut 06901
Lot#:
8L4B3521
Exp Date:
12/31/2023
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Deltoid (HL70163:  RD)
Vaccine Group:
Hep A
Administered:
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) HAVRIX (NDC 58160-0825-43)
Date Administered:
11/23/2018
Additional Observations:

Dose #:
1
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
6359RT33
Exp Date:
1/4/2019
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Deltoid (HL70163:  RD)
Vaccine Group:
Hep A
Administered:
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) HAVRIX (NDC 58160-0825-43)
Date Administered:
05/23/2019
Additional Observations:

Dose #:
2
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
6359RT48
Exp Date:
09/11/2019
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163:  LD)
Vaccine Group:
MMR
Administered:
measles, mumps, rubella virus vaccine (CVX 03) MMR II (NDC 00006-4681-01)
Date Administered:
08/22/2018
Additional Observations:
Invalid because it was given too soon
Dose #:

Doses in Series:
2
Valid Dose:
N
Ordering Provider:
Frank Smith
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Sandra Molina
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
0853CC
Exp Date:
12/15/2018
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Thigh (HL70163:  LT)
Vaccine Group:
MMR
Administered:
measles, mumps, rubella virus vaccine (CVX 03)
MMR II (00006-4681-01)
Date Administered:
09/22/2021
Additional Observations:

Dose #:
1
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
0854FF
Exp Date:
4/13/2022
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Arm (HL70163:  LA)
Vaccine Group:
MMR
Administered:
measles, mumps, rubella virus vaccine (CVX 03) MMR II (NDC 00006-4681-01)
Date Administered:
14 days PRIOR to day of TEST
Additional Observations:

Dose #:
2
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Frank Smith
Entered By:
Sandra Molina
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Sandra Molina
Administered at Location:
400 Shoreline Drive, Stamford Connecticut 06901
Lot#:
0934GG
Exp Date:
12/31/2023
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Arm (HL70163:  LA)
Vaccine Group:
Varicella
Administered:
Varicella vaccine (CVX 21) Varivax (NDC 00006-4827-01)
Date Administered:
12/15/2019
Additional Observations:

Dose #:
1
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
 Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
2341BB
Exp Date:
12/1/2020
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Right Arm (HL70163:  RA)
Vaccine Group:
IPV
Due Date:
10/31/2021
Earliest Date to Give:
10/31/2021
Overdue Date:
10/31/2023
Immunization Schedule:
ACIP
Vaccine Group:
Varicella
Due Date:
10/31/2021
Earliest Date to Give:
10/31/2021
Overdue Date:
10/31/2023
Immunization Schedule:
ACIP

Notes

If the same immunization report verified in TestCase 4 for Juana Mariana Vazquez is used for the patient access to the immunization record, then content verification does not need to be repeated.

Influenza vaccine should be due between September and October of the flu season, which may show as the prior year to testing or the year of testing.

Also, since MMR was given 2 weeks prior, forecasting of immunizations due may be adjusted by the vendor forecast to account for the requirement there must be at least 28 days between immunizations using a live virus. Tester should document incidences where the forecast is adjusted or annotated as a result of this requirement.


2.5.2. Provide access to Printable Immunization Record for Juana Mariana Vazquez

Test Step Type: SUT_MANUAL
The EHR is used to provide a printable immunization record for Juana Mariana Vazquez.

Test Story

Description

Following the vaccination visit, the patient/parent uses the specified interface to print the immunization report for the patient including all history and forecast information.  


Comments

No Comments


Pre-condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. New vaccinations have been administered. The parent/patient is provided with an account to access the immunization history.


Post-Condition

The patient/parent has been provided a printed copy of the patient immunization history report.


Test Objectives

Provide Access to Patient Immunization Record: The EHR or other clinical software system provides patients and their authorized representatives with electronic access to immunization records (either directly or by interacting with an external system such as a patient portal).

Provide Access to Printable Immunization Record: The EHR or other clinical software system provides a printable version of the immunization record.


Evaluation Criteria

Using the patient facing features (e.g. portal), show that the vaccine history including today’s vaccine/forecast can be printed:

The following patient demographics are included in the printable report:


Patient Identifier Number:
Vendor Assigned
Patient Identifier Type Code:
Vendor Assigned
Patient Name:
Juana Mariana Vazquez
Date/Time of Birth:
11/01/2017 11:05am
Sex:
Female
Patient Address:
4345 Standish Way, Stamford, CT, 06903
Multiple Birth Indicator:
No
Birth Order:
N/A


The following Vaccination History is available in printed report:

Vaccine Group:
Hep B Peds NOS
Administered:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-43)
Date Administered:
11/01/2017
Additional Observations:
None
Dose #:
1
Doses in Series:
3
Valid Dose:
Y
Ordering Provider:
Jane Carter
Entered By:
Lisa Sirtis
Entering Organization:
Shoreline Hospital
Administered Amt:
0.5 mL
Administering Provider:
Jane Carter
Administered at Location:
325 Shoreline Drive, Stamford Connecticut 06901
Lot#:
6332FK33
Exp Date:
12/14/2017
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
Hep B Peds NOS
Administered:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) ENGERIX-B (NDC 58160-0820-43)
Date Administered:
12/20/2017
Additional Observations:
None
Dose #:
2
Doses in Series:
3
Valid Dose:
Y
Ordering Provider:
Frank Smith
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Sandra Molina
Administered at Location:
400 Shoreline Drive, Stamford Connecticut 06901
Lot#:
6352FK1
Exp Date:
12/31/2017
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
Hep B Peds NOS
Administered:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) ENGERIX-B (NDC 58160-0820-43)
Date Administered:
05/20/2018
Additional Observations:
None
Dose #:
3
Doses in Series:
3
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Sandra Molina
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
6352FK24
Exp Date:
8/31/2019
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
diphtheria, tetanus toxoids and acellular pertussis vaccine
Administered:
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) DAPTACEL (NDC 49281-0286-58)
Date Administered:
1/22/2018
Additional Observations:
None
Dose #:
1
Doses in Series:
5
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D409QS2341
Exp Date:
11/30/2018
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
diphtheria, tetanus toxoids and acellular pertussis vaccine
Administered:
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) DAPTACEL (NDC 49281-0286-58)
Date Administered:
3/23/2018
Additional Observations:

Dose #:
2
Doses in Series:
5
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D409QS2433
Exp Date:
9/4/2018
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Thigh (HL70163: RT)
Vaccine Group:
diphtheria, tetanus toxoids and acellular pertussis vaccine
Administered:
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) DAPTACEL (NDC 49281-0286-58)
Date Administered:
5/22/2018
Additional Observations:

Dose #:
3
Doses in Series:
5
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D409QS3255
Exp Date:
12/1/2018
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
diphtheria, tetanus toxoids and acellular pertussis vaccine
Administered:
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) DAPTACEL (NDC 49281-0286-58)
Date Administered:
2/21/2019
Additional Observations:

Dose #:
4
Doses in Series:
5
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D409QS249
Exp Date:
3/1/2019
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
diphtheria, tetanus toxoids and acellular pertussis vaccine
Administered:
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) DAPTACEL (NDC 49281-0286-58)
Date Administered:
11/20/2021
Additional Observations:

Dose #:
5
Doses in Series:
5
Valid Dose:
Y
Ordering Provider:
J. Rodriguez
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Linda Casera
Administered at Location:
4253 Standish Way, Stamford Connecticut 06903
Lot#:
D643QS8243
Exp Date:
12/01/2021
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
Hib
Administered:
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) PedvaxHIB (NDC 00006-4897-01)
Date Administered:
1/22/2018
Additional Observations:

Dose #:
1
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
7M54K9245
Exp Date:
3/24/2018
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Thigh (HL70163: RT)
Vaccine Group:
Hib
Administered:
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) PedvaxHIB (NDC 00006-4897-01)
Date Administered:
3/23/2018
Additional Observations:

Dose #:
2
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
7M55K3342
Exp Date:
10/30/2018
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
Hib
Administered:
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) PedvaxHIB (NDC 00006-4897-01)
Date Administered:
5/22/2018
Additional Observations:

Dose #:
3
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
7M75K4566
Exp Date:
5/23/2018
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Thigh (HL70163: RT)
Vaccine Group:
Hib
Administered:
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) PedvaxHIB (NDC 00006-4897-01)
Date Administered:
11/21/2018
Additional Observations:

Dose #:
4
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
7M53K5534
Exp Date:
2/22/2019
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
poliovirus vaccine, inactivated
Administered:
poliovirus vaccine, inactivated (CVX 10) IPOL (NDC 49281-0860-88)
Date Administered:
1/22/2018
Additional Observations:

Dose #:
1
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D333PV2431
Exp Date:
10/4/2018
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Arm (HL70163: LA)
Vaccine Group:
poliovirus vaccine, inactivated
Administered:
poliovirus vaccine, inactivated (CVX 10) IPOL (NDC 49281-0860-88)
Date Administered:
3/23/2018
Additional Observations:
None
Dose #:
2
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D333PV4344
Exp Date:
3/23/2019
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Arm (HL70163: LA)
Vaccine Group:
poliovirus vaccine, inactivated
Administered:
poliovirus vaccine, inactivated (CVX 10) IPOL (NDC 49281-0860-88)
Date Administered:
2/21/2019
Additional Observations:
Adverse Reaction of (VXC12^fever of >40.5C (105F) within 48 hours of dose^CDCPHINVS)
Dose #:
3
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
J. Rodriguez
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Linda Casera
Administered at Location:
4253 Standish Way, Stamford Connecticut 06903
Lot#:
D335PV9644
Exp Date:
4/22/2019
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Arm (HL70163: LA)
Vaccine Group:
pneumococcal
Administered:
pneumococcal conjugate vaccine, 13 valent (CVX 133) PREVNAR 13 (NDC 00005-1971-01)
Date Administered:
1/22/2017
Additional Observations:

Dose #:
1
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
P243V3281
Exp Date:
1/30/2018
Manufacturer:
Pfizer, Inc (MVX PFR)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
pneumococcal
Administered:
pneumococcal conjugate vaccine, 13 valent (CVX 133) PREVNAR 13 (NDC 00005-1971-01)
Date Administered:
3/23/2018
Additional Observations:

Dose #:
2
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
P343V8321
Exp Date:
3/30/2018
Manufacturer:
Pfizer, Inc (MVX PFR)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
pneumococcal
Administered:
pneumococcal conjugate vaccine, 13 valent (CVX 133) PREVNAR 13 (NDC 00005-1971-01)
Date Administered:
5/22/2018
Additional Observations:

Dose #:
3
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
P853V2164
Exp Date:
8/30/2018
Manufacturer:
Pfizer, Inc (MVX PFR)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Thigh (HL70163: RT)
Vaccine Group:
pneumococcal
Administered:
pneumococcal conjugate vaccine, 13 valent (CVX 133) PREVNAR 13 (NDC 00005-1971-01)
Date Administered:
1/11/2019
Additional Observations:

Dose #:
4
Doses in Series:
4
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
P853V58532
Exp Date:
4/18/2019
Manufacturer:
Pfizer, Inc (MVX PFR)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
Rotavirus
Administered:
rotavirus, live, monovalent vaccine (CVX 119) ROTARIX (NDC 58160-0851-01)
Date Administered:
1/22/2018
Additional Observations:

Dose #:
1
Doses in Series:
3
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
1 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
6359RV533
Exp Date:
2/15/2018
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Oral (NCIT: C38288, HL70162 : PO)
Site:
(N/A)
Vaccine Group:
Rotavirus
Administered:
rotavirus, live, monovalent vaccine (CVX 119) ROTARIX (NDC 58160-0851-01)”
Date Administered:
3/23/2018
Additional Observations:

Dose #:
2
Doses in Series:
3
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
1 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
6359RV932
Exp Date:
5/10/2018
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Oral (NCIT: C38288, HL70162 : PO)
Site:
(N/A)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0898-41)
Date Administered:
9/25/2018
Additional Observations:

Dose #:
1
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D8043IN8734
Exp Date:
7/25/2019
Manufacturer:
Sanofi Pasteur Inc (MVX PMC)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0898-41)
Date Administered:
10/29/2018
Additional Observations:

Dose #:
2
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D8043IN8746
Exp Date:
3/12/2019
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Thigh (HL70163: RT)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0896-41)
Date Administered:
10/2/2019
Additional Observations:

Dose #:

Doses in Series:

Valid Dose:

Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D9334IN9333
Exp Date:
5/22/2020
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0885-41)
Date Administered:
11/04/2020
Additional Observations:

Dose #:

Doses in Series:

Valid Dose:

Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
D9553IN2243
Exp Date:
04/30/2021
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0887-41)
Date Administered:
10/15/2021
Additional Observations:

Dose #:

Doses in Series:

Valid Dose:

Ordering Provider:
Gina Ricci
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Gina Ricci
Administered at Location:
Oceanview Pharmacy, 15 Post Road, Stamford Connecticut 06901
Lot#:
8L4B3423|
Exp Date:
12/30/2021
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
Influenza
Administered:
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0890-41)
Date Administered:
Current Date
Additional Observations:
Adverse Reaction of (VXC14^Rash within 14 days of dose ^CDCPHINVS)
Dose #:

Doses in Series:

Valid Dose:

Ordering Provider:
Frank Smith
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Sandra Molina
Administered at Location:
400 Shoreline Drive, Stamford Connecticut 06901
Lot#:
8L4B3521
Exp Date:
12/31/2023
Manufacturer:
GlaxoSmithKline (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Deltoid (HL70163: RD)
Vaccine Group:
Hep A
Administered:
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) HAVRIX (NDC 58160-0825-43)
Date Administered:
11/23/2018
Additional Observations:

Dose #:
1
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
6359RT33
Exp Date:
1/4/2019
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Right Deltoid (HL70163: RD)
Vaccine Group:
Hep A
Administered:
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) HAVRIX (NDC 58160-0825-43)
Date Administered:
5/23/2019
Additional Observations:

Dose #:
2
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
6359RT48
Exp Date:
9/11/2019
Manufacturer:
GlaxoSmithKline Biologicals SA (MVX SKB)
Route:
Intramuscular (NCIT: C28161, HL70162: IM)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
MMR
Administered:
measles, mumps, rubella virus vaccine (CVX 03) MMR II (NDC 00006-4681-01)
Date Administered:
08/22/2018
Additional Observations:
Invalid because it was given too soon
Dose #:

Doses in Series:
2
Valid Dose:
N
Ordering Provider:
Frank Smith
Entered By:
Sandra Molina
Entering Organization:
Shoreline Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Sandra Molina
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
0853CC
Exp Date:
12/15/2018
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Thigh (HL70163: LT)
Vaccine Group:
MMR
Administered:
measles, mumps, rubella virus vaccine (CVX 03) MMR II (00006-4681-01)
Date Administered:
9/22/2021
Additional Observations:

Dose #:
1
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
0854FF
Exp Date:
4/13/2022
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Arm (HL70163: LA)
Vaccine Group:
MMR
Administered:
measles, mumps, rubella virus vaccine (CVX 03) MMR II (NDC 00006-4681-01)
Date Administered:
14 days PRIOR to day of TEST
Additional Observations:

Dose #:
2
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Frank Smith
Entered By:
Sandra Molina
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
Sandra Molina
Administered at Location:
400 Shoreline Drive, Stamford Connecticut 06901
Lot#:
0934GG
Exp Date:
12/31/2023
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Left Deltoid (HL70163: LD)
Vaccine Group:
Varicella
Administered:
Varicella vaccine (CVX 21) Varivax (NDC 00006-4827-01)
Date Administered:
12/15/2019
Additional Observations:

Dose #:
1
Doses in Series:
2
Valid Dose:
Y
Ordering Provider:
Carlos Herrera
Entered By:
J. Martinez
Entering Organization:
Oceanview Pediatrics
Administered Amt:
0.5 mL
Administering Provider:
J. Martinez
Administered at Location:
333 Oceanview Lane, Stamford Connecticut 06901
Lot#:
2341BB
Exp Date:
12/1/2020
Manufacturer:
Merck and Co Inc (MVX MSD)
Route:
Subcutaneous (NCIT: C38299, HL70162: SC)
Site:
Right Arm (HL70163: RA)
Vaccine Group:
IPV
Due Date:
10/31/2021
Earliest Date to Give:
10/31/2021
Overdue Date:
10/31/2023
Immunization Schedule:
ACIP
Vaccine Group:
Varicella
Due Date:
10/31/2021
Earliest Date to Give:
10/31/2021
Overdue Date:
10/31/2023
Immunization Schedule:
ACIP

Notes

If the same immunization report verified in TestCase 4 for Juana Mariana Vazquez is used for the patient access to the immunization record, then content verification does not need to be repeated.

Influenza vaccine should be due between September and October of the flu season, which may show as the prior year to testing or the year of testing.

Also, since MMR was given 2 weeks prior, forecasting of immunizations due may be adjusted by the vendor forecast to account for the requirement there must be at least 28 days between immunizations using a live virus. Tester should document incidences where the forecast is adjusted or annotated as a result of this requirement.


2.5.3. Provide access to Vaccine Information Statements

Test Step Type: SUT_MANUAL
The EHR is used to provide the patient access to the Vaccine Information Statements.

Test Story

Description

The EHR is used to provide the patient access to the Vaccine Information Statements (VIS) for those vaccines administered during the visit.


Comments

No Comments


Pre-condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. New vaccinations have been administered. The parent/patient is provided with an account to access the Vaccine Information Statements (VIS).


Post-Condition

The patient/parent has been provided access to the Vaccine Information Statements (VIS) for those vaccines administered during the visit.


Test Objectives

Provide Access to Recommendations and Vaccine Information Statement(s): The immunization record displays immunization recommendations to be discussed with a provider, displaying the relevant Vaccine Information Statement.


Evaluation Criteria

Using the patient facing features (e.g. portal), show that the patient can access the Vaccine Information Statements (VIS) for those vaccines administered during today's visit:

Vaccine VIS
VIS Fully-Encoded Text String
Edition Date
Location
Influenza Vaccine VIS
253088698300010311210806
 8/6/2021 (current)
https://www.cdc.gov/vaccines/hcp/vis/vis-statements/flu.html

Notes

The VIS may be provided as a link, PDF, or other format, but the VIS must be the current VIS for the product administered during the visit.

The EHR does not need to provide access to VIS from historical vaccinations.


3. Juan Marcel Marina Visit

Juan Marcel Marina visits the provider where his immunization history is retrieved from the registry and reconciled with the local information in the medical record to determine vaccines that are due. Vaccinations are ordered and administered. The vaccines are reported to the immunization registry and a vaccine summary is available for the patient.

Test Story

Description

Comments

Pre-condition

Post-Condition

Test Objectives

Evaluation Criteria

Notes

3.1. Query the Registry for Juan Marcel Marina

EHR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juan Marcel Marina.

Test Story

Description

Querying the registry will consist of the vendor creating Z44 messages for Juan Marcel Marina to be sent to the registry. The response will be processed as part of the 'Display, Reconcile, Import and Update Immunization Information' activity.

Using the Z42 Response to Immunization Registry Query, the EHR displays the Evaluated History and Forecast to the user for reconciliation and update. The vendor will receive information back from the registry and show the ability to view and reconcile, and import the information returned by the registry (NOTE: the Z42 message will be provided either manually, or as part of the tool). This test will also look at the system's ability to view the forecast returned by the registry and create a new forecast after reconciling the information.



Comments

No Comments


Pre-condition

Juan Marcel Marina is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juan Marcel Marina Initial Data Load'.


Post-Condition

A Z44 Query is generated and submitted to the Immunization Registry/Test tool, and a Z42 response is returned.


Test Objectives

Select New Patient: The EHR or other clinical system system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software system. This information is crucial for identifying and selecting the correct patient.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules.

 

Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44) - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

 

Request/Receive Patient Immunization Data and Identify Source: The EHR stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.

 

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations.


Review Patient Immunization History: The EHR or other clinical software system displays vaccine history by vaccine series.

 

Support for:

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


3.1.1. Select Patient Juan Marcel Marina

Test Step Type: SUT_MANUAL
Select patient Juan Marcel Marina, distinguishing the patient from other patients with similar demographics (similar names).

Test Story

Description

Juan Marcel Marina is selected as the patient and his record is opened in the EHR.


Comments

No Comments


Pre-condition

Juan Marcel Marina Initial Data Load completed.


Post-Condition

Juan Marcel Marina is the active working patient in the EHR.


Test Objectives

Select New Patient: The EHR or other clinical software system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software system. This information is crucial for identifying and selecting the correct patient.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules.


Evaluation Criteria

Tester shall verify that the product can distinguish Juan Marcel Marina from similar sounding names using all of the pediatric demographics:


Patient ID (previously listed as “Medicaid Number”)
Vendor supplied
Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name
Shoreline Pediatrics
Patient ID: Type (e.g., medical record number, IIS ID)
Vendor supplied
Patient Name: First
Juan
Patient Name: Middle
Marcel
Patient Name: Last
Marina
Patient Date of Birth
03/04/2021
Birth Time
11:00AM
Patient Gender (Administrative Sex)
M
Patient Multiple Birth Indicator
No
Patient Birth Order
N/A
Responsible Person Name: First
Manuel
Responsible Person Name: Middle
Marcel
Responsible Person Name: Last
Marina
Responsible Person Name: Relationship to Patient
Father
Mother’s Name: First
Anita
Mother’s Name: Middle
Francesca
Mother’s Name: Last
Marina
Mother’s Name: Maiden Last
Morales
Patient Address: Street
4623 Standish Way
Patient Address: City
Stamford
Patient Address: State
CT
Patient Address: Country
USA
Patient Address: Zipcode
06903
Race
White
Ethnicity
Hispanic or Latino
Patient Primary Language
English
Patient Telephone Number
(203) 555-1213
Patient Telephone Number Type (e.g., home, cell)
Cell
Patient E-mail Address
None
Publicity Code- Reminder/recall
no calls (03 HL70215)
Publicity Code Effective Date
03/04/2021

Protection Indicator
No
Protection Indicator Effective Date
03/04/2021
Immunization Registry Status
Active
Preferred Contact Method
Text




Notes

No Note


3.1.2. Query Registry for vaccination history and forecast for Juan Marcel Marina

Test Step Type: SUT_INITIATOR
The EHR generates a Z44 query for immunization history and forecast correctly and without omission according to supplied test data.

Test Story

Description

The provider uses the EHR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.


Comments

No Comments


Pre-condition

Juan Marcel Marina Initial Data Load is completed.

Juan Marcel Marina is the active working patient in the EHR.


Post-Condition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juan Marcel Marina.


Test Objectives

Request/Receipt of Patient Immunization History: The EHR or other clinical system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44)  - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).


Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EHR and contains all test data attributes supplied.


Notes

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.4 Assigning Authority
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Marina Value-Test Case Fixed
QPD-4.2 Given Name Juan Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Marcel Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales Value-Test Case Fixed
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 202103041100 Value-Test Case Fixed
QPD-7 Patient Sex M Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4623 Standish Way Value-Test Case Fixed
QPD-8.2 Other Designation
QPD-8.3 City Stamford Value-Test Case Fixed
QPD-8.4 State or Province CT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 06903 Value-Test Case Fixed
QPD-8.6 Country USA
QPD-8.7 Address Type L Value-Test Case Fixed
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type CP Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203 Value-Test Case Fixed
QPD-9.7 Local Number 5551213 Value-Test Case Fixed
QPD-10 Multiple birth indicator N Value-Test Case Fixed
QPD-11 Birth order

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1
RCP-2.2 Units
RCP-2.2.1 Identifier RD
RCP-2.2.2 Text Records
RCP-2.2.3 Name of Coding System HL70126

Test Data Specification

Patient Information
Element Data
Patient Name Juan Marcel Marina
Mother's Maiden Name Morales
ID Number 123456
Date/Time of Birth 03/04/2021 11:00
Sex Male
Patient Address 4623 Standish Way Stamford CT 06903 USA
Patient Phone (203)555-1213
Birth Indicator No
Birth Order

3.1.3. View and import response to request for vaccination history for Juan Marcel Marina

Test Step Type: TA_RESPONDER
The EHR displays the Immunization History results (Z42) returned in response to the Z44 Query and import them into the EHR.

Test Story

Description

The physician accesses the record for Juan Marcel Marina and:

- Accepts the vaccines provided by the registry as this is a new patient and there are no prior vaccines recorded.


Comments

There is no reconciliation step as there are no historical immunizations in the EHR. All will be imported from the Z42 response.


Pre-condition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR and the response is available in the EHR for reconciliation and import.



Post-Condition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juan Marcel Marina).


Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.

 

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if they choose to do so. The system must store the new information as structured data as part of the patient's local immunization history and include the time of the update and the source of the new information.

 

Review Patient Immunization History: The EHR or other clinical software system displays vaccine history by vaccine series.


Supporting data for:

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.


Evaluation Criteria

1. The EHR displays the information returned from the Immunization Registry according to the Juror Document.

2. The user imports returned vaccinations as follows using only the vaccination, and administration dates returned from the Immunization Registry:

Vaccinations Imported:

hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 3/4/2021
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 4/15/2021
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 5/15/2021
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 7/13/2021
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 9/16/2021
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 8/20/2022
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/14/2021
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 7/21/2021
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 9/27/2021
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/4/2022
poliovirus vaccine, inactivated (CVX 10) administered 5/14/2021
poliovirus vaccine, inactivated (CVX 10) administered 7/21/2021
poliovirus vaccine, inactivated (CVX 10) administered 10/15/2021
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/18/2021
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 7/21/2021
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 9/27/2021
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/4/2022
rotavirus, live, monovalent vaccine (CVX 119) administered 5/18/2021
rotavirus, live, monovalent vaccine (CVX 119) administered 9/21/2021
influenza, injectable, quadrivalent, preservative free (CVX 150) administered 9/27/2021
influenza, injectable, quadrivalent, preservative free (CVX 150) administered 10/27/2022
measles, mumps, rubella virus vaccine (CVX 03) administered 6/20/2022

Notes

The EHR must minimally display the vaccine administered and the date of the immunization.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Marina
QPD-4.2 Given Name Juan
QPD-4.3 Second and Further Given Names or Initials Thereof Marcel
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales
QPD-5.7 Name Type Code L
QPD-6 PatientDateOfBirth
QPD-6.1 Time 202103041100
QPD-7 Patient Sex M
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4623 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country USA
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type CP
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551213
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Marina
PID-5.2 Given Name Juan
PID-5.3 Second and Further Given Names or Initials Thereof Marcel
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 202103041100
PID-8 Administrative Sex M
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4623 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID SH
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SH
ORC-17.2 Text Shoreline Hospital
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210304
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210415
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210515
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210713
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210916
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20220820
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210514
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210721
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210927
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20220504
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210514
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text Polio (IPV)
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text MSanofi Pasteur Inc.
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210721
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text Polio (IPV)
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text MSanofi Pasteur Inc.
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20211015
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text Polio (IPV)
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text MSanofi Pasteur Inc.
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210518
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210721
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210927
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20220504
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210518
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text Rotavirus
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 1.0
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210921
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text Rotavirus
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 1.0
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210927
RXA-5 Administered Code
RXA-5.1 Identifier 150
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20211027
RXA-5 Administered Code
RXA-5.1 Identifier 150
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20220620
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text measles, mumps, rubella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288
RXR-1.2 Text Oral
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288
RXR-1.2 Text Oral
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text hepatitis B vaccine, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210304

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210304

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210304

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210304

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210304

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text hepatitis B vaccine, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 202104150515

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 202104150515

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 202104150515

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 202104150515

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 202104150515

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210515

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210515

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210515

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210515

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210515

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210713

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210713

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210713

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210713

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210713

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210916

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210916

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210916

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210916

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210916

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220820

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220820

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220820

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220820

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220820

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210514

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210514

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210514

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210514

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210514

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210721

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210721

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210721

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210721

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210721

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210927

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210927

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210927

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210927

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210927

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220504

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220504

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220504

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220504

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220504

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210514

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210514

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210514

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210514

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210514

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210721

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210721

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210721

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210721

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210721

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20211015

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20211015

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20211015

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20211015

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20211015

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210518

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210518

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210518

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210518

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210518

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210721

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210721

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210721

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210721

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210721

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210927

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210927

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210927

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210927

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210927

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220504

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220504

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220504

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220504

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220504

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210518

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210518

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210518

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210518

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210518

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210921

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210921

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210921

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210921

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210921

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210927

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210927

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210927

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210927

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20210927

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20211027

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20211027

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20211027

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20211027

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20211027

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220620

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220620

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220620

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220620

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220620

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text Hep B, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20220904
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20220904
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221004
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20220904
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20220304
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20220304
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, pediatric, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20220304
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20220304
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Juan Marcel Marina
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juan Marcel Marina
Date of Birth 03/04/2021
Sex Male
Address 1
Street 4623 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Anita Francesca Morales
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Shoreline Hospital
Vaccine Group hepatitis B vaccine, unspecified formulation
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 03/04/2021
Date/Time Administration-End 03/04/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID SH
Street Address 325 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group hepatitis B vaccine, unspecified formulation
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 04/15/2021
Date/Time Administration-End 04/15/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered DTaP
Refusal Reason
Date/Time Administration-Start 05/15/2021
Date/Time Administration-End 05/15/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered DTaP
Refusal Reason
Date/Time Administration-Start 07/13/2021
Date/Time Administration-End 07/13/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered DTaP
Refusal Reason
Date/Time Administration-Start 09/16/2021
Date/Time Administration-End 09/16/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered DTaP
Refusal Reason
Date/Time Administration-Start 08/20/2022
Date/Time Administration-End 08/20/2022
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Hib
Refusal Reason
Date/Time Administration-Start 05/14/2021
Date/Time Administration-End 05/14/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Thigh
Substance Manufacturer Name Merck and Co Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Hib
Refusal Reason
Date/Time Administration-Start 07/21/2021
Date/Time Administration-End 07/21/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name Merck and Co Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Hib
Refusal Reason
Date/Time Administration-Start 09/27/2021
Date/Time Administration-End 09/27/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Thigh
Substance Manufacturer Name Merck and Co Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Hib
Refusal Reason
Date/Time Administration-Start 05/04/2022
Date/Time Administration-End 05/04/2022
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name Merck and Co Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered Polio (IPV)
Refusal Reason
Date/Time Administration-Start 05/14/2021
Date/Time Administration-End 05/14/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Arm
Substance Manufacturer Name MSanofi Pasteur Inc.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered Polio (IPV)
Refusal Reason
Date/Time Administration-Start 07/21/2021
Date/Time Administration-End 07/21/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Arm
Substance Manufacturer Name MSanofi Pasteur Inc.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered Polio (IPV)
Refusal Reason
Date/Time Administration-Start 10/15/2021
Date/Time Administration-End 10/15/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Arm
Substance Manufacturer Name MSanofi Pasteur Inc.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered Pneumococcal conjugate (PCV13)
Refusal Reason
Date/Time Administration-Start 05/18/2021
Date/Time Administration-End 05/18/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered Pneumococcal conjugate (PCV13)
Refusal Reason
Date/Time Administration-Start 07/21/2021
Date/Time Administration-End 07/21/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered Pneumococcal conjugate (PCV13)
Refusal Reason
Date/Time Administration-Start 09/27/2021
Date/Time Administration-End 09/27/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered Pneumococcal conjugate (PCV13)
Refusal Reason
Date/Time Administration-Start 05/04/2022
Date/Time Administration-End 05/04/2022
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name Pfizer, Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered Rotavirus
Refusal Reason
Date/Time Administration-Start 05/18/2021
Date/Time Administration-End 05/18/2021
Administered Amount 1.0
Administered Units of Measure mL
Route of Administration Oral
Administration Site
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered Rotavirus
Refusal Reason
Date/Time Administration-Start 09/21/2021
Date/Time Administration-End 09/21/2021
Administered Amount 1.0
Administered Units of Measure mL
Route of Administration Oral
Administration Site
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable, quadrivalent, preservative free
Refusal Reason
Date/Time Administration-Start 09/27/2021
Date/Time Administration-End 09/27/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable, quadrivalent, preservative free
Refusal Reason
Date/Time Administration-Start 10/27/2021
Date/Time Administration-End 10/27/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group MMR
Vaccine Administered measles, mumps, rubella virus vaccine
Refusal Reason
Date/Time Administration-Start 06/20/2022
Date/Time Administration-End 06/20/2022
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Thigh
Substance Manufacturer Name Merck and Co Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID OP
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Hep B, unspecified formulation
Vaccine Due Date 09/04/2022
Earliest Date to Give 09/04/2022
Latest Date to Give
Date When Vaccine Overdue 10/04/2022
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/04/2022
Earliest Date to Give 03/04/2022
Latest Date to Give
Date When Vaccine Overdue
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 03/04/2022
Earliest Date to Give 03/04/2022
Latest Date to Give
Date When Vaccine Overdue
Status in Immunization Series
Forecast Reason
Vaccine Group Hep A, pediatric, unspecified formulation
Vaccine Due Date 03/04/2022
Earliest Date to Give 03/04/2022
Latest Date to Give
Date When Vaccine Overdue
Status in Immunization Series
Forecast Reason

3.1.4. View the vaccination forecast for Juan Marcel Marina

Test Step Type: SUT_MANUAL
The EHR displays the current Immunization Forecast to the user for Juan Marcel Marina either as returned by the IIS in prior step, or as generated through any local means.

Test Story

Description

The physician accesses the record for Juan Marcel Marina and, once the vaccine history is reconciled in the EHR, the vaccine forecast is updated.

- The provider views the updated vaccine forecast (either as provided by the Immunization Registry or as determined through EHR defined methods).


Comments

The vaccine forecast may be imported from the Immunization Registry Vaccination History and Forecast (Z42) response, or it may be generated by EHR defined means.


Pre-condition

EHR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Juan Marcel Gonzales).



Post-Condition

A vaccine forecast based upon the imported vaccine history is available to the user.


Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations.


Modify Antigen Recommendations Based on Active Diagnoses: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses.


Evaluation Criteria

1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:

2. Verify that the EHR includes in the vaccine forecast:

Hep B Peds NOS due on 9/4/2022
influenza, unspecified formulation due on Sep 4, 2022 or later (annual recommendation – specific date may vary somewhat)

In support of test objective 'Modify Antigen Recommendations Based on Active Diagnoses' the tester verifies that the system notifies the provider that:

Varicella due on 3/4/2022 – Forecast should not show that they need vaccine for Varicella; because of known diagnosis.
Hep A is due 3/4/2022 – Forecast may not show that they need the vaccine for Hepatitis A due to serologic immunity to the disease.

Notes

The due date must be in range for the date shown. Vaccine forecast dates may be plus or minus 10 days to accommodate differences in date handling.

Further variation should be documented in the notable exceptions, but minimally each forecast vaccine must be present.

While there is not an expected  recommendation for the earliest date to give for influenza, this may appear in some EHR implementations. Tester should note if this is included.

Tester should document how evidence of prior disease (Varicella) is documented (e.g. if not in forecast, is there a reason available to clinician).

Manual override does not fulfill the 'modify antigen recommendations based on active diagnoses' (e.g. if the system does not support this through CDS then not fulfilled).

This criteria is considered 'Advanced', so tester should note support for this criteria separately.


3.2. Juan Marcel Marina, Enter Orders and Immunizations

Orders and Immunization events, non-administrations, and alerts presented for current visit.

Test Story

Description

This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients.


Comments

No Comments


Pre-condition

Juan Marcel Marina is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juan Marcel Marina Initial Data Load.'


Post-Condition

Visit orders are entered in Juan Marcel Marina's record.


Test Objectives

Modify Antigen Recommendations Based on Active Diagnoses: The EHR or other clinical software system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses.

 

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.

 

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.


Receive Dose Not Indicated Alert Upon Vaccine Administration: The EHR or other clinical software system notifies the individual administering a vaccine that the vaccine is inconsistent with expected timing intervals as suggested by the vaccine forecast. The method and timing of notification can be specified to meet local clinical workflow. This requirement is a “failsafe” mechanism in case the provider orders a vaccine dose that is inconsistent with appropriate timing intervals.

 

Notify of Vaccine Dose Expiration: The EHR or other clinical software system notifies the provider administering a vaccine if the dose chosen for administration is expired.

 

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type,  lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine).


Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS.

 

Notify of Vaccine Dose Ineligibility: The EHR or other clinical software system provides a method for alerting a provider if a vaccine is selected for a patient who is not eligible for the inventory item selected.


Add Jurisdiction-Specific Vaccine Eligibility Code: The EHR or other clinical software system demonstrates the ability to configure publicly funded dose level vaccine eligibility codes per jurisdictional requirements. This includes tracking and exchanging jurisdiction-specific dose level eligibility code(s) for administered vaccines. This capability only applies to newly administered doses, not historical doses.


Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

 Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

   - 2013: Indicates that the funding source code in an OBX segment conflicts with other data in the message (eligibility, age etc).

   - 2016: Indicates that the administration route is inconsistent with the vaccine administered 

   - 2001: Indicates a conflict between the administration date in RXA-3 and the expiration date in RXA-16. In other words it indicates that an expired vaccine was administered.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


3.2.1. Orders Administration of Hepatitis B vaccine

Test Step Type: SUT_MANUAL
The provider orders a Hepatitis B vaccine (dose 3).

Test Story

Description

As indicated by the vaccine forecast, the third Hepatitis B is overdue, and is ordered.


Comments

No Comments


Pre-condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. Vaccine forecast reviewed.


Post-Condition

Hepatitis B vaccine is ordered for the patient.



Test Objectives

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.


Evaluation Criteria

The EHR records the following order information: The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:


Entered BY
Sandra Molina
Ordering Provider
Frank Smith
Entering Organization
Shoreline Pediatrics
Vaccine Event information source
New immunization record (NIP001 00)
Order Value/Text for Vaccine Type
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08, NDC 58160-0820-43)
Date/Time Vaccine was recorded
Current Date



Notes

No Note


3.2.2. Orders administration of DTaP vaccine and alerted that the dose is too early

Test Step Type: SUT_MANUAL
The provider orders a DTaP vaccine (dose 5). The EHR provides an alert that the vaccine dose is too early.

Test Story

Description

The fifth DTaP is ordered, and the provider is notified that the dose is too early.


Comments

No Comments


Pre-condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. Vaccine forecast is available in the EHR.


Post-Condition

DTaP vaccine is ordered for the patient, and provider is notified that the dose is too early.



Test Objectives

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.

 

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.


Evaluation Criteria

The EHR records the following order information and Alert. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

Entered BY
Sandra Molina
Ordering Provider
Frank Smith
Entering Organization
Shoreline Pediatrics
Vaccine Event information source
New immunization record (NIP001 00)
Value/Text for Vaccine Type
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
Date/Time Vaccine order was recorded
Current Date
Alert
Notification that the dose is too early



Notes

In step 8 of this TestCase, there will be a request to attempt to record this DTaP dose, which is also expected to result in an alert notification. There may be systems that require an alert override to establish this DTaP order to be able to execute Step 8: Attempt to administer DTaP vaccine and alerted that the dose is too early.


3.2.3. Attempt to record HepB Vaccine administration route with data validation checking

Test Step Type: SUT_MANUAL
The provider records the vaccine administration route in the EHR and is prevented from incorrectly documenting vaccine route.

Test Story

Description

The nurse documents administration route for the HepB vaccine:

- Is prevented from documenting "oral" for HepB vaccine.


Comments

This step covers data quality checking as an informative aspect of vaccine administration.


Pre-condition

Order is placed for HepB vaccine.


Post-Condition

The HepB vaccination route has failed to be recorded as 'oral' in the EHR.


Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine).

Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

   - 2016 : Indicates that the administration route is inconsistent with the vaccine administered 


Evaluation Criteria

The EHR warns the user that 'Oral' as a route for the HepB vaccine is not correct.



Notes

Verification checking for invalid route or site should not prevent the user from selecting the alternate route or site. While this test case example is not one that would make sense to ignore the warning, there are situations where an alternate site or route may be medically indicated. This test should not be interpreted to restrict the ability of the EHR to document such alternate routes or sites that may be intentionally selected by the clinician.


3.2.4. Records Hepatitis B Vaccine lot number with expired lot alert

Test Step Type: SUT_MANUAL
The provider records the vaccine administration lot number in the EHR and is alerted of the expired lot.

Test Story

Description

The nurse documents administration lot number for the Hepatitis B vaccine:

- Is prevented from ordering the Hepatitis B lot as it has expired.

- Documents administration from a different lot that is not expired.


Comments

No Comments


Pre-condition

Order is placed for Hepatitis B vaccine.


Post-Condition

The provider has been notified of the expired Hepatitis B vaccination lot. Documentation of a lot to be administered that is not expired is recorded in the EHR.


Test Objectives

Notify of Vaccine Dose Expiration: The EHR or other clinical software system notifies the provider administering a vaccine if the dose chosen for administration is expired.

Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS.

Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

   - 2001: Indicates a conflict between the administration date in RXA-3 and the expiration date in RXA-16. In other words, it indicates that an expired vaccine was administered.


Evaluation Criteria

During the course of data entry for the variant information below, the EHR triggers the following data quality issues:

  • Triggers indication that an expired vaccine was administered (2001)

The EHR records the following order information and Alert. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

The EHR records the following vaccine administration information, and using the 2D Barcode found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:


Entered BY
Sandra Molina

Ordering Provider
Frank Smith

Entering Organization
Shoreline Pediatrics

Vaccine Event information source
New immunization record (NIP001 00)

Date/Time of Start of Administration
Current Date

Vaccine Administered
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-43)

Vaccine 2D Barcode

Lot Number (Expired)
6332FK18

Substance Expiration Date (Expired)
06/15/2022
Triggers indication that an expired vaccine was administered (2001)
Substance Manufacturer Name
GlaxoSmithKline Biologicals SA (MVX SKB)

Alert
Alerts user to expired lot



Notes

The full vaccination details are provided here to facilitate the documentation constraints and/or screens that may be required by the vendor in order to attempt to document the data of interest, but these are not verified until the next step. Only those attributes specified that are anticipated to result in data quality alerts are required for this step.

If the EHR or other clinical system is not supporting the Jurisdiction-specific eligibility code, then mark VFC Eligibility as non-VFC Eligible.


3.2.5. Record Hepatitis B Vaccine administration

Test Step Type: SUT_MANUAL
The EHR is able to document all attributes associated with the new vaccine administration.

Test Story

Description

The nurse administers the Hepatitis B vaccine:

- Documents all required information for the vaccine.



Comments

No Comments


Pre-condition

Order is placed for Hepatitis B vaccine.



Post-Condition

The Hepatitis B vaccination is recorded in the EHR.


Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine).


Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS.

 

Add Jurisdiction-Specific Vaccine Eligibility Code: The EHR or other clinical software system demonstrates the ability to configure dose level vaccine eligibility codes per jurisdictional requirements. This includes tracking and exchanging a jurisdiction-specific dose level eligibility code for administered vaccines. Note that this capability only applies to newly administered doses, not historical doses.



Evaluation Criteria

The EHR records the following vaccine administration information. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions.

The EHR records the following vaccine administration information, and using the 2D Barcode found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:

Ordering Provider
Frank Smith
Entering Organization
Shoreline Pediatrics
Vaccine Event information source
New immunization record (NIP001 00)
Date/Time of Start of Administration
Current Date
Vaccine Administered
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-43)
Vaccine 2D Barcode
Administered Amount (of Vaccine)
0.5
Administered Units (of Measure)
mL
Administration Notes

Administering Provider
Sandra Molina
Administered-at Location
400 Shoreline Drive, Stamford Connecticut 06901
Lot Number
6332FK26
Substance Expiration Date
12/31/2023
Substance Manufacturer Name
GlaxoSmithKline Biologicals SA (MVX SKB)
Completion Status
Completed (CP)
Route of Administration
Intramuscular (NCIT C28161, HL70162: IM)
Administration Site
Left Deltoid (HL70163 LD)
Vaccine Program Eligibility
IIP021 - Privately Insured
Funding Source
Public non-VFC (VXC52)
VIS Given Date
Current Date
VIS Fully Encoded Text-String
253088698300005911211015



Notes

The EHR does not need to specify a 'new immunization', as long as there is a way to indicate that it is a new immunization within the EHR, this is acceptable (e.g. the default interpretation of the data entry is that it is a new immunization and not historical).

If the EHR or other clinical system is not supporting the Jurisdiction-specific eligibility code, then mark Vaccine Program Eligibility as non-VFC Eligible using Private funding source.


3.2.6. Records Influenza Vaccine administration with VFC eligibility checking

Test Step Type: SUT_MANUAL
The provider records the vaccine administration from a VFC source and alerted that the patient is not VFC eligible.

Test Story

Description

The nurse documents administration for the inactivated influenza vaccine from a VFC source: 

- Is alerted that the patient is not eligible for VFC.

- Orders a different non-VFC lot of inactivated influenza vaccine.


Comments

No Comments


Pre-condition

Order is placed for inactivated influenza vaccine.


Post-Condition

The user is notified of vaccine dose ineligibility.


Test Objectives

Notify of Vaccine Dose Ineligibility: The EHR or other clinical software system provides a method for alerting a provider if a vaccine is selected for a patient who is not eligible for the inventory item selected.

Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS.

Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

 Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

  -  2013: Indicates that the funding source code in an OBX segment conflicts with other data in the message (eligibility, age etc).


Evaluation Criteria

The provider documents a VFC lot to be administered in the EHR. Once notified that the patient is not eligible for the VFC, then a non-VFC lot is selected. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

The EHR records the following vaccine administration information, and using the 2D Barcode found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:

Entered BY
Sandra Molina
Ordering Provider
Frank Smith
Entering Organization
Shoreline Pediatrics
Vaccine Event information source
New immunization record (NIP001 00)
Value/Text for Vaccine Type
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT
(NDC 58160-0890-41)
Date/Time of Start of Administration
Current Date
Vaccine Administered
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT
(NDC 58160-0890-41)
Unit of Use 2D Barcode
VFC lot (not administered)
D8043IN8422
Substance Expiration Date
12/31/2023
Substance Manufacturer Name
GlaxoSmithKline (MVX SKB)
Alert
Patient is not VFC Eligible
Funding Source
Private


The Provider selects a non-VFC Lot:

Vaccine Lot # (administered):
D8043IN8855
Vaccine Expiration Date:
12/31/2023

Notes

The full vaccination details are provided here to facilitate the documentation constraints and/or screens that may be required by the vendor in order to attempt to document the data of interest, but these are not verified until the next step. Only those attributes specified that are anticipated to result in data quality alerts are required for this step.

 Administration for the non-VFC dose of this vaccine is completed in the next step.


3.2.7. Record Influenza Vaccine administration for Juan Marcel Marina

Test Step Type: SUT_MANUAL
The EHR is able to document all attributes associated with the new vaccine administration.

Test Story

Description

The nurse administers the inactivated influenza vaccine:

- Documents all required information for each vaccine.





Comments

No Comments


Pre-condition

Order is placed for inactivated influenza vaccine.


Post-Condition

The inactivated influenza vaccine administration is recorded in the EHR.



Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine).


Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS.




Evaluation Criteria

The EHR records the following vaccine administration information. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions.

The EHR records the following vaccine administration information, and using the 2D Barcode found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:

Entered BY
Sandra Molina
Ordering Provider
Frank Smith
Entering Organization
Shoreline Pediatrics
Vaccine Event information source (Administration Notes)
New immunization record (NIP001 00)
Value/Text for Vaccine Type
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0890-41)
Date/Time of Start of Administration
Current Date
Vaccine Administered
Influenza, injectable, quadrivalent, preservative free (CVX 150)
FLUARIX QUADRIVALENT (NDC 58160-0890-41)
Unit of Use 2D Barcode
Administered Amount (of Vaccine)
0.5
Administered Units (of Measure)
mL
Administering Provider
Sandra Molina
Administered-at Location
400 Shoreline Drive, Stamford Connecticut 06901
Lot Number
D8043IN8855
Substance Expiration Date
12/31/2023
Substance Manufacturer Name
GlaxoSmithKline (MVX SKB)
Completion Status
CP
Route of Administration
Intramuscular (NCIT C28161, HL70162: IM)
SiteLeft Deltoid (HL70163 LD)
VFC Eligibility
No
Funding Source
Private
VIS Given Date
Current Date
VIS Fully Encoded Text-String
253088698300010311210806




Notes

The EHR does not need to specify a 'new immunization', as long as there is a way to indicate that it is a new immunization within the EHR, this is acceptable (e.g. the default interpretation of the data entry is that it is a new immunization and not historical).


3.2.8. Attempt to administer DTaP vaccine and alerted that the dose is too early

Test Step Type: SUT_MANUAL
The provider attempts to administer a DTaP vaccine (dose 5). The EHR provides an alert that the vaccine dose is too early.

Test Story

Description

The provider attempts to administer the fifth DTaP vaccine, and the provider is notified that the dose is too early.



Comments

No Comments


Pre-condition

Order is placed for DTaP vaccine.


Post-Condition

DTaP vaccine is not administered to the patient, following notification that the dose is too early.



Test Objectives

Receive Dose Not Indicated Alert Upon Vaccine Administration: The EHR or other clinical software system notifies the individual administering a vaccine that the vaccine is inconsistent with expected timing intervals as suggested by the vaccine forecast. The method and timing of notification can be specified to meet local clinical workflow. This requirement is a “failsafe” mechanism in case the provider orders a vaccine dose that is inconsistent with appropriate timing intervals.




Evaluation Criteria

The provider prepares to administer the 5th DTaP vaccine, and system alerts the provider that the dose is too early. The provider records the following order information with an indication of a similar Alert.:

Entered By
Sandra Molina
Ordering Provider
Frank Smith
Entering Organization
Shoreline Pediatrics
Vaccine Event information source
New immunization record (NIP001 00)
Value/Text for Vaccine Type
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
Date/Time Vaccine order was recorded
Current Date
Alert
Notification that the dose is too early



Notes

The EHR may not allow for recording of a vaccine administration if the DTaP has not been ordered. This may require an override or alert acceptance in Step 2: Orders administration of DTaP vaccine and alerted that the dose is too early.

2D Barcode is not included as this test case does not result in a vaccine administration.


3.3. Juan Marcel Marina Transmit Immunization Report

Send the Immunization Report to the Immunization Registry (VXU/Z22) for Juan Marcel Marina.

Test Story

Description

Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EHR imported from the IIS.



Comments

No Comments


Pre-condition

The vaccines for the visit have been administered.


Post-Condition

The IIS has received the vaccine information (Z22 message).


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries. 

Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.

Note: Testing for NDC codes, CVX for immunizations.

Add Jurisdiction-Specific Vaccine Eligibility Code: The EHR or other clinical software system demonstrates the ability to configure dose level vaccine eligibility codes per jurisdictional requirements. This includes tracking and exchanging a jurisdiction-specific dose level eligibility code for administered vaccines. Note that this capability only applies to newly administered doses, not historical doses.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


3.3.1. Transmit the Immunization Report for Juan Marcel Marina

Test Step Type: SUT_INITIATOR
The EHR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This includes all newly administered vaccines and may include historical information updated in the EHR during the visit. This also includes notification that Varicella is not administered due to history of the disease.

Test Story

Description

Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines, and an indication that Varicella was not administered due to a history of the disease as evidence of immunity. The Vaccination report also includes an indication that Hepatitis A was not administered due to serological evidence of immunity. The report MAY send the immunizations that the EHR imported from the IIS.


Comments

The Report must include all newly administered vaccines in any order. The report may include the information imported from the IIS.


Pre-condition

The vaccines for the visit have been administered. The clinical information has been documented for Juan Marcel Marina in the Initial Data Load.


Post-Condition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.

Note: Testing for NDC codes, CVX for immunizations.

Add Jurisdiction-Specific Vaccine Eligibility Code: The EHR or other clinical software system demonstrates the ability to configure dose level vaccine eligibility codes per jurisdictional requirements. This includes tracking and exchanging a jurisdiction-specific dose level eligibility code for administered vaccines. Note that this capability only applies to newly administered doses, not historical doses.


Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

This includes indication that Varicella was not administered due to history of the disease, and an indication that Hepatitis A was not administered due to serological evidence of immunity.


Notes

All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘).

If the EHR or other clinical system is not supporting the Jurisdiction-specific eligibility code, then OBX observation for VFC-Eligibility may pass with notable exception using vaccine program eligibility as non-VFC Eligible and OBX observation for funding source using Private funding source.

The message may fail to validate because the new Vaccine Program Eligibility code is not in the HL70064_IZ code set. This is expected behavior and the system may pass with notable exception.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIPEHRFAC Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code XX Presence-Content Indifferent
MSH-22.10 Organization Identifier 100-1 Presence-Content Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIPIISFAC Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code XX Presence-Content Indifferent
MSH-23.10 Organization Identifier 100-2 Presence-Content Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Marina Value-Test Case Fixed
PID-5.2 Given Name Juan Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Marcel Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Morales Value-Test Case Fixed
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 202103041100 Value-Test Case Fixed
PID-8 Administrative Sex M Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Value-Test Case Fixed
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4623 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford Value-Test Case Fixed
PID-11.4 State or Province CT Value-Test Case Fixed
PID-11.5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type L Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551213 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Value-Test Case Fixed
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator N Value-Test Case Fixed
PID-25 Birth Order
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 03 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - no calls Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20210304
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20210304 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20210304 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Marina
NK1-2.2 Given Name Manuel Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Marcel Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier FTH Value-Test Case Fixed
NK1-3.2 Text Father Value-Test Case Fixed
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 4623 Standish Way
NK1-4.2 Other Designation
NK1-4.3 City Stamford Value-Test Case Fixed
NK1-4.4 State or Province CT Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 06903 Value-Test Case Fixed
NK1-4.6 Country
NK1-4.7 Address Type L Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 203 Value-Test Case Fixed
NK1-5.7 Local Number 5551213 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID SH
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Sirtis Presence-Content Indifferent
ORC-10.3 Given Name Lisa Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Carter Presence-Content Indifferent
ORC-12.3 Given Name Jane Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SH Presence-Content Indifferent
ORC-17.2 Text Shoreline Hospital Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Presence-Content Indifferent
ORC-12.3 Given Name Frank Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Presence-Content Indifferent
ORC-12.3 Given Name Frank Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197029
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez Presence-Content Indifferent
ORC-10.3 Given Name J. Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP Presence-Content Indifferent
ORC-17.2 Text Oceanview Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Indifferent
ORC-10.3 Given Name Sandra Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Indifferent
ORC-12.3 Given Name Frank Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Indifferent
ORC-17.2 Text Shoreline Pediatrics Indifferent
ORC-17.3 Name of Coding System HL70362 Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210304 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text Hepatitis B Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6332FK34
RXA-16 Substance Expiration Date
RXA-16.1 Time 20211214
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210415 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text Hepatitis B Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6352FK2
RXA-16 Substance Expiration Date
RXA-16.1 Time 20211001
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text Hepatitis B Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Presence-Content Indifferent
RXA-10.3 Given Name Sandra Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6332FK26 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20231231 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Biologicals SA Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210515 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text DTaP Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D409QS2342
RXA-16 Substance Expiration Date
RXA-16.1 Time 20221130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210713 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text DTaP Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D409QS2434
RXA-16 Substance Expiration Date
RXA-16.1 Time 20210904
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210916 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text DTaP Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D409QS3256
RXA-16 Substance Expiration Date
RXA-16.1 Time 20211201
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20220820 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 106 Value-Test Case Fixed
RXA-5.2 Text DTaP Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D409QS250
RXA-16 Substance Expiration Date
RXA-16.1 Time 20230301
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210514 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Hib Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 7M54K9255
RXA-16 Substance Expiration Date
RXA-16.1 Time 20220324
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210721 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Hib Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 7M55K3343
RXA-16 Substance Expiration Date
RXA-16.1 Time 20211030
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210927 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Hib Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 7M75K4577
RXA-16 Substance Expiration Date
RXA-16.1 Time 20220523
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20220504 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 49 Value-Test Case Fixed
RXA-5.2 Text Hib Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 7M53K5535
RXA-16 Substance Expiration Date
RXA-16.1 Time 20221014
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210514 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text Polio (IPV) Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D333PV2444
RXA-16 Substance Expiration Date
RXA-16.1 Time 20221004
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc.
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210721 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text Polio (IPV) Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D333PV4343
RXA-16 Substance Expiration Date
RXA-16.1 Time 20220323
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc.
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20211015 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 10 Value-Test Case Fixed
RXA-5.2 Text Polio (IPV) Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D333PV9654
RXA-16 Substance Expiration Date
RXA-16.1 Time 20220222
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc.
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210518 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text Pneumococcal conjugate (PCV13) Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number P243V3321
RXA-16 Substance Expiration Date
RXA-16.1 Time 20220130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210721 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text Pneumococcal conjugate (PCV13) Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number P343V8445
RXA-16 Substance Expiration Date
RXA-16.1 Time 20220330
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210927
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text Pneumococcal conjugate (PCV13) Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number P853V2175
RXA-16 Substance Expiration Date
RXA-16.1 Time 20220830
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20220504 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 133 Value-Test Case Fixed
RXA-5.2 Text Pneumococcal conjugate (PCV13) Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number P853V58544
RXA-16 Substance Expiration Date
RXA-16.1 Time 20221018
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210518 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 119 Value-Test Case Fixed
RXA-5.2 Text Rotavirus Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6359RV543
RXA-16 Substance Expiration Date
RXA-16.1 Time 20211029
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210921 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 119 Value-Test Case Fixed
RXA-5.2 Text Rotavirus Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6359RV933
RXA-16 Substance Expiration Date
RXA-16.1 Time 20220510
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210927 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 150 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D8043IN8738
RXA-16 Substance Expiration Date
RXA-16.1 Time 20220312
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20211027 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 150 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D8043IN8798
RXA-16 Substance Expiration Date
RXA-16.1 Time 20220522
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 150 Value-Test Case Fixed
RXA-5.2 Text Influenza, injectable, quadrivalent, preservative free Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Presence-Content Indifferent
RXA-10.3 Given Name Sandra Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number D8043IN8855 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20231231 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20220620 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 03 Value-Test Case Fixed
RXA-5.2 Text measles, mumps, rubella virus vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez Presence-Content Indifferent
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 7W27V7632
RXA-16 Substance Expiration Date
RXA-16.1 Time 20231215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20220316 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 998 Value-Test Case Fixed
RXA-5.2 Text No vaccine administered Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier Indifferent
RXA-9.2 Text
RXA-9.3 Name of Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Indifferent
RXA-10.3 Given Name Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier Indifferent
RXA-17.2 Text Indifferent
RXA-17.3 Name of Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20220115 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 998 Value-Test Case Fixed
RXA-5.2 Text No vaccine administered Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier Indifferent
RXA-9.2 Text
RXA-9.3 Name of Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LA
RXR-2.2 Text Left Arm
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288
RXR-1.2 Text Oral
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288
RXR-1.2 Text Oral
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type TS Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date vaccine information statement presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300005911211015 Presence-Content Indifferent
OBX-5.2 Text Hepatitis B Vaccine VIS
OBX-5.3 Name of Coding System cdcgs1vis Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier IIP021 Value-Test Case Fixed
OBX-5.2 Text HEPB09- Privately Insured Presence-Content Indifferent
OBX-5.3 Name of Coding System HL70064 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier VXC52 Presence-Content Indifferent
OBX-5.2 Text Public non-VFC
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300010311210806 Value-Test Case Fixed
OBX-5.2 Text Influenza Vaccine - Inactivated VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text VIS Presentation Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier V01 Value-Test Case Fixed
OBX-5.2 Text Not VFC elig Presence-Content Indifferent
OBX-5.3 Name of Coding System HL70064 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3
OBX-3.2 Text Vaccine funding source
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier PHC70
OBX-5.2 Text Private
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7 Value-Test Case Fixed
OBX-3.2 Text vaccine type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21 Value-Test Case Fixed
OBX-5.2 Text varicella Presence-Content Indifferent
OBX-5.3 Name of Coding System CVX Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220316
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59784-9 Value-Test Case Fixed
OBX-3.2 Text Disease with presumed immunity Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 38907003 Presence-Content Indifferent
OBX-5.2 Text History of Varicella infection
OBX-5.3 Name of Coding System SCT
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220316
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7 Value-Test Case Fixed
OBX-3.2 Text vaccine type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85 Value-Test Case Fixed
OBX-5.2 Text Hep A, pediatric, unspecified formulation Presence-Content Indifferent
OBX-5.3 Name of Coding System CVX Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220115
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 75505-8
OBX-3.2 Text Diseases with serological evidence of immunity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 278971009
OBX-5.2 Text Serology confirmed hepatitis A
OBX-5.3 Name of Coding System SCT
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220115
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juan Marcel Marina
Mother's Maiden Name Anita Morales
ID Number 123456 987633
Date/Time of Birth 03/04/2021 11:00
Administrative Sex Male
Patient Address 4623 Standish Way Stamford CT 06903 USA
Local Number (203)555-1213
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator No
Birth Order
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 03/04/2021
Publicity Code Reminder/recall - no calls
Publicity Code Effective Date 03/04/2021
Protection Indicator No
Protection Indicator Effective Date 03/04/2021
Guardian or Responsible Party
Element Data
Name Manuel Marcel Marina
Relationship Father
Address 4623 Standish Way Stamford CT 06903
Phone Number (203)555-1213

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis B
Date/Time Start of Administration 03/04/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 6332FK34
Substance Expiration Date 12/14/2021
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis B
Date/Time Start of Administration 04/15/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 6352FK2
Substance Expiration Date 10/01/2021
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis B
Date/Time Start of Administration 10/31/2022
Administered Amount 0.5
Administered Units
Administration Notes
Administering Provider Sandra Molina
Substance Lot Number 6332FK26
Substance Expiration Date 12/31/2023
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Date vaccine information statement presented 10/31/2022
Document Type Hepatitis B Vaccine VIS
vaccine fund pgm elig cat HEPB09- Privately Insured
Vaccine funding source Public non-VFC

Vaccine Administration Information
Element Data
Administered Vaccine DTaP
Date/Time Start of Administration 05/15/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D409QS2342
Substance Expiration Date 11/30/2022
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine DTaP
Date/Time Start of Administration 07/13/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D409QS2434
Substance Expiration Date 09/04/2021
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine DTaP
Date/Time Start of Administration 09/16/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D409QS3256
Substance Expiration Date 12/01/2021
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine DTaP
Date/Time Start of Administration 08/20/2022
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D409QS250
Substance Expiration Date 03/01/2023
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Hib
Date/Time Start of Administration 05/14/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7M54K9255
Substance Expiration Date 03/24/2022
Substance Manufacturer Name Merck and Co Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Hib
Date/Time Start of Administration 07/21/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7M55K3343
Substance Expiration Date 10/30/2021
Substance Manufacturer Name Merck and Co Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Hib
Date/Time Start of Administration 09/27/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7M75K4577
Substance Expiration Date 05/23/2022
Substance Manufacturer Name Merck and Co Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Hib
Date/Time Start of Administration 05/04/2022
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7M53K5535
Substance Expiration Date 10/14/2022
Substance Manufacturer Name Merck and Co Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Polio (IPV)
Date/Time Start of Administration 05/14/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D333PV2444
Substance Expiration Date 10/04/2022
Substance Manufacturer Name Sanofi Pasteur Inc.
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Arm
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Polio (IPV)
Date/Time Start of Administration 07/21/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D333PV4343
Substance Expiration Date 03/23/2022
Substance Manufacturer Name Sanofi Pasteur Inc.
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Arm
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Polio (IPV)
Date/Time Start of Administration 10/15/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D333PV9654
Substance Expiration Date 02/22/2022
Substance Manufacturer Name Sanofi Pasteur Inc.
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Arm
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Pneumococcal conjugate (PCV13)
Date/Time Start of Administration 05/18/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number P243V3321
Substance Expiration Date 01/30/2022
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Pneumococcal conjugate (PCV13)
Date/Time Start of Administration 07/21/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number P343V8445
Substance Expiration Date 03/30/2022
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Pneumococcal conjugate (PCV13)
Date/Time Start of Administration 09/27/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number P853V2175
Substance Expiration Date 08/30/2022
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Pneumococcal conjugate (PCV13)
Date/Time Start of Administration 05/04/2022
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number P853V58544
Substance Expiration Date 10/18/2022
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Rotavirus
Date/Time Start of Administration 05/18/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 6359RV543
Substance Expiration Date 10/29/2021
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Oral
Administration Site
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Rotavirus
Date/Time Start of Administration 09/21/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 6359RV933
Substance Expiration Date 05/10/2022
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Oral
Administration Site
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable, quadrivalent, preservative free
Date/Time Start of Administration 09/27/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D8043IN8738
Substance Expiration Date 03/12/2022
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable, quadrivalent, preservative free
Date/Time Start of Administration 10/27/2021
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D8043IN8798
Substance Expiration Date 05/22/2022
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine Influenza, injectable, quadrivalent, preservative free
Date/Time Start of Administration 10/31/2022
Administered Amount 0.5
Administered Units
Administration Notes
Administering Provider Sandra Molina
Substance Lot Number D8043IN8855
Substance Expiration Date 12/31/2023
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Document Type Influenza Vaccine - Inactivated VIS
VIS Presentation Date 10/31/2022
vaccine fund pgm elig cat Not VFC elig
Vaccine funding source Private

Vaccine Administration Information
Element Data
Administered Vaccine measles, mumps, rubella virus vaccine
Date/Time Start of Administration 06/20/2022
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7W27V7632
Substance Expiration Date 12/15/2023
Substance Manufacturer Name Merck and Co Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Subcutaneous
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Vaccine No vaccine administered
Date/Time Start of Administration 03/16/2022
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status Not Administered
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
vaccine type varicella
Disease with presumed immunity History of Varicella infection

Vaccine Administration Information
Element Data
Administered Vaccine No vaccine administered
Date/Time Start of Administration 01/15/2022
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status Not Administered
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
vaccine type Hep A, pediatric, unspecified formulation
Diseases with serological evidence of immunity Serology confirmed hepatitis A

3.3.2. Receive ACK Z23 from Immunization Registry

Test Step Type: TA_RESPONDER
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Test Story

Description

The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.


Comments

No Comments


Pre-condition

A VXU message is generated by the EHR.


Post-Condition

The ACK Z23 is received by the EHR.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.


Evaluation Criteria

The acknowledgement message is consumed by the system responsible for the content of the administration message without error.


Notes

Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031073734.034-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-1.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-AD-1.1_Send_V04_Z22

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

3.3.3. Transmit Delete for Vaccine Recorded in Error

Test Step Type: SUT_INITIATOR
The Provider realizes that the notification that the Hepatitis B vaccine that was not administered was inadvertently documented and transmitted to the registry. A delete notification for the Hepatitis B vaccination administered is transmitted to the Immunization Registry.

Test Story

Description

The provider identifies that the vaccine administration of Hepatitis B for this visit was documented in error. The vaccine was not administered during the visit but was inadvertently documented as administered. A delete notification for the Hepatitis B vaccination administered is transmitted to the Immunization Registry for Juan Marcel Marina.


Comments

No Comments


Pre-condition

The vaccinations for the visit have been administered.

The vaccination report (Z22) has been transmitted to the IIS, including the record of the Hepatitis B vaccination which was inadvertently documented as administered.

.


Post-Condition

The EHR has recorded that the hepatitis B vaccination was documented in error. Juan Marcel Marina's record is updated to reflect that the immunization was not given. The Delete notification for this vaccination has been transmitted to the Immunization Registry.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.

Note: Testing for NDC codes, CVX for immunizations.

Add Jurisdiction-Specific Vaccine Eligibility Code: The EHR or other clinical software system demonstrates the ability to configure dose level vaccine eligibility codes per jurisdictional requirements. This includes tracking and exchanging a jurisdiction-specific dose level eligibility code for administered vaccines. Note that this capability only applies to newly administered doses, not historical doses.

Support for delete functionality.


Evaluation Criteria

Verify that EHR can correct the vaccination documented in error. Verify that the vaccination record for Juan Marcel Marina for the Hepatitis B vaccination given on the date of the test is marked as invalid.

Verify that a valid Delete notification is transmitted to the Immunization Registry for this vaccination: The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.


Notes

All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘).

If the EHR or other clinical system is not supporting the Jurisdiction-specific eligibility code, then OBX observation for VFC-Eligibility may pass with notable exception using vaccine program eligibility as non-VFC Eligible and OBX observation for funding source using Private funding source.

The message may fail to validate because the new Vaccine Program Eligibility code is not in the HL70064_IZ code set. This is expected behavior and the system may pass with notable exception.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIPEHRFAC Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code XX Presence-Content Indifferent
MSH-22.10 Organization Identifier 100-1 Presence-Content Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIPIISFAC Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code XX Presence-Content Indifferent
MSH-23.10 Organization Identifier 100-2 Presence-Content Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Marina Value-Test Case Fixed
PID-5.2 Given Name Juan Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Marcel Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Morales Value-Test Case Fixed
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 202103041100 Value-Test Case Fixed
PID-8 Administrative Sex M Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Value-Test Case Fixed
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4623 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford Value-Test Case Fixed
PID-11.4 State or Province CT Value-Test Case Fixed
PID-11.5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type L Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551213 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator N Value-Test Case Fixed
PID-25 Birth Order
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 03
PD1-11.2 Text Reminder/recall - no calls
PD1-11.3 Name of Coding System HL70215
PD1-12 Protection Indicator N
PD1-13 Protection Indicator Effective Date 20210304
PD1-16 Immunization Registry Status A
PD1-17 Immunization Registry Status Effective Date 20210304
PD1-18 Publicity Code Effective Date 20210304

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Marina
NK1-2.2 Given Name Manuel Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Marcel Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier FTH Value-Test Case Fixed
NK1-3.2 Text Father Value-Test Case Fixed
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 4623 Standish Way
NK1-4.2 Other Designation
NK1-4.3 City Stamford Value-Test Case Fixed
NK1-4.4 State or Province CT Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 06903 Value-Test Case Fixed
NK1-4.6 Country
NK1-4.7 Address Type L Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 203 Value-Test Case Fixed
NK1-5.7 Local Number 5551213 Value-Test Case Fixed

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Presence-Content Indifferent
ORC-10.3 Given Name Sandra Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text Hepatitis B Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6332FK26
RXA-16 Substance Expiration Date
RXA-16.1 Time 20231231
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA D Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text Date vaccine information statement presented
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document Type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300005911211015
OBX-5.2 Text Hepatitis B Vaccine VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7
OBX-3.2 Text vaccine fund pgm elig cat
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier IIP021 Value-Test Case Fixed
OBX-5.2 Text HEPB09- Privately Insured
OBX-5.3 Name of Coding System HL70064
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3
OBX-3.2 Text Vaccine funding source
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier VXC52
OBX-5.2 Text Public non-VFC
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juan Marcel Marina
Mother's Maiden Name Anita Morales
ID Number 123456 987633
Date/Time of Birth 03/04/2021 11:00
Administrative Sex Male
Patient Address 4623 Standish Way Stamford CT 06903 USA
Local Number (203)555-1213
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator No
Birth Order
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 03/04/2021
Publicity Code Reminder/recall - no calls
Publicity Code Effective Date 03/04/2021
Protection Indicator No
Protection Indicator Effective Date 03/04/2021
Guardian or Responsible Party
Element Data
Name Manuel Marcel Marina
Relationship Father
Address 4623 Standish Way Stamford CT 06903
Phone Number (203)555-1213

Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis B
Date/Time Start of Administration 10/31/2022
Administered Amount 0.5
Administered Units
Administration Notes
Administering Provider Sandra Molina
Substance Lot Number 6332FK26
Substance Expiration Date 12/31/2023
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Delete
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Date vaccine information statement presented 10/31/2022
Document Type Hepatitis B Vaccine VIS
vaccine fund pgm elig cat HEPB09- Privately Insured
Vaccine funding source Public non-VFC

3.3.4. Receive ACK Z23 from Immunization Registry

Test Step Type: TA_RESPONDER
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Test Story

Description

The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.


Comments

No Comments


Pre-condition

A VXU message is generated by the EHR.


Post-Condition

The ACK Z23 is received by the EHR.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.


Evaluation Criteria

The acknowledgement message is consumed by the system responsible for the content of the administration message without error.


Notes

Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031073734.034-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-1.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-AD-1.1_Send_V04_Z22

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

4. Juana Mariela Gonzales Visit

Infant twin, Juana Mariela Gonzales visits the provider where her immunization history is retrieved from the registry and reconciled with the local information in the medical record to determine vaccines that are due. Vaccinations are ordered and administered. The vaccines are reported to the immunization registry and a vaccine summary is available for the patient.

Test Story

Description

Comments

Pre-condition

Post-Condition

Test Objectives

Evaluation Criteria

Notes

4.1. Query the Registry for Juana Mariela Gonzales

The EHR generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Mariela Gonzales.

Test Story

Description

The EHR generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Mariela Gonzales. Querying the registry will consist of the vendor creating Z44 messages for Juana Mariela Gonzales to be sent to the registry. The response will be processed as part of the 'Display, Reconcile, Import and Update Immunization Information' activity.

Using the Z42 Response to Immunization Registry Query, the EHR displays the Evaluated History and Forecast to the user for reconciliation and update. The vendor will receive information back from the registry and show the ability to view and reconcile, and import the information returned by the registry (NOTE: the Z42 message will be provided either manually, or as part of the tool). This test will also look at the system's ability to view the forecast returned by the registry and create a new forecast after reconciling the information.



Comments

No Comments


Pre-condition

Juana Mariela Gonzales is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the Juana Mariela Gonzales Initial Data Load.


Post-Condition

A Z44 Query is generated and submitted to the Immunization Registry/Test tool, and a Z42 response is returned.


Test Objectives

Select New Patient: The EHR or other clinical software system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software. This information is crucial for identifying and selecting the correct patient.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules.

 

Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44)  - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

 

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.

 

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations.



Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


4.1.1. Select Patient Juana Mariela Gonzales

Test Step Type: SUT_MANUAL
Select patient Juana Mariela Gonzales, Infant Twin, distinguishing the patient from other patients with similar demographics (twins).

Test Story

Description

Juana Mariela Gonzales is selected as the patient and her record is opened in the EHR.


Comments

No Comments


Pre-condition

Juana Mariela Gonzales Initial Data Load completed.


Post-Condition

Juana Mariela Gonzales is the active working patient in the EHR.


Test Objectives

Select New Patient: The EHR or other clinical software system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software. This information is crucial for identifying and selecting the correct patient.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules.


Evaluation Criteria

Tester shall verify that the product can distinguish Juana Mariela Gonzales from similar sounding names and her twin using all of the pediatric demographics:


Patient ID (previously listed as “Medicaid Number”)
Vendor supplied
Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name
Shoreline Pediatrics
Patient ID: Type (e.g., medical record number, IIS ID)
Vendor supplied
Patient Name: First
Juana
Patient Name: Middle
Mariela
Patient Name: Last
Gonzales
Patient Date of Birth
10/01/2022
Birth Time
11:00am
Patient Gender (Administrative Sex)
F
Patient Multiple Birth Indicator
Yes
Patient Birth Order
1
Responsible Person Name: First
Joanna
Responsible Person Name: Middle
Elena
Responsible Person Name: Last
Gonzales
Responsible Person Name: Relationship to Patient
Mother
Mother’s Name: First
Joanna
Mother’s Name: Middle
Elena
Mother’s Name: Last
Gonzales
Mother’s Name: Maiden Last
Morales
Patient Address: Street
3321 Standish Way
Patient Address: City
Stamford
Patient Address: State
CT
Patient Address: Country
USA
Patient Address: Zipcode
06903
Race
White
Ethnicity
Hispanic or Latino
Patient Primary Language
English
Patient Telephone Number
(203) 555-1214
Patient Telephone Number Type (e.g., home, cell)
Cell
Patient E-mail Address
None
Publicity Code
Reminder/recall – no calls (03 HL70215)
Publicity Code Effective Date
10/01/2022

Protection Indicator
No
Protection Indicator Effective Date
10/01/2022
Immunization Registry Status
Active
Preferred Contact Method
Text



Notes

Patient last name from the hospital returned by the IIS is Morales (the mother's maiden name). The patient's last name in the EHR should be Gonzales. This test verifies that the EHR can match the returned record despite the different last name.



4.1.2. Query Registry for vaccination history and forecast for Juana Mariela Gonzales

Test Step Type: SUT_INITIATOR
The EHR generates a Z44 query for immunization history and forecast correctly and without omission according to supplied test data.

Test Story

Description

The provider uses the EHR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.


Comments

No Comments


Pre-condition

Juana Mariela Gonzales Initial Data Load is completed.

Juana Mariela Gonzales is the active working patient in the EHR.


Post-Condition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Mariela Gonzales.


Test Objectives

Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44)  - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).


Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EHR and contains all test data attributes supplied.


Notes

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales Value-Test Case Fixed
QPD-4.2 Given Name Juana Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Mariela Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales Value-Test Case Fixed
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 202210011100 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way Value-Test Case Fixed
QPD-8.2 Other Designation
QPD-8.3 City Stamford Value-Test Case Fixed
QPD-8.4 State or Province CT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 06903 Value-Test Case Fixed
QPD-8.6 Country USA
QPD-8.7 Address Type L Value-Test Case Fixed
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type CP Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203 Value-Test Case Fixed
QPD-9.7 Local Number 5551214 Value-Test Case Fixed
QPD-10 Multiple birth indicator Y Value-Test Case Fixed
QPD-11 Birth order 1 Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1
RCP-2.2 Units
RCP-2.2.1 Identifier RD
RCP-2.2.2 Text Records
RCP-2.2.3 Name of Coding System HL70126

Test Data Specification

Patient Information
Element Data
Patient Name Juana Mariela Gonzales
Mother's Maiden Name Morales
ID Number
Date/Time of Birth 10/01/2022 11:00
Sex Female
Patient Address 3321 Standish Way Stamford CT 06903 USA
Patient Phone (203)555-1214
Birth Indicator Yes
Birth Order 1

4.1.3. View and import response to request for vaccination history for Juana Mariela Gonzales

Test Step Type: TA_RESPONDER
The EHR displays the Immunization History results (Z42) returned in response to the Z44 Query and import them into the EMR.

Test Story

Description

The physician accesses the record for Juana Mariela Gonzales and:

- Accepts the single vaccine in the registry record into the EHR history.


Comments

There is no reconciliation step as there are no historical immunizations in the EHR. All will be imported from the Z42 response.



Pre-condition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR and the response is available in the EHR for reconciliation and import.


Post-Condition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariela Gonzales).


Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.


Evaluation Criteria

1. The EHR displays the information returned from the Immunization Registry according to the Juror Document.

2. The user imports returned vaccinations as follows:

Vaccinations Imported:

hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 10/1/2022.



Notes

If the EHR is unable to match and import the previous immunization record, they will need to add the following historical immunization manually:

Vaccine from Practice HepB


Entered By
Susan Pike
Y
Ordering Provider
Justin Parker
Y
Entering Organization
Stamford Regional Hospital
Y
Administration Notes (Vaccine Event information source)
New immunization record (NIP001 00)
Y
Date/Time of Start of Administration
10/01/2022
Y
Vaccine Administered
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08, NDC 58160-0820-43)
Y
Administered Amount (of Vaccine)
0.5
Y
Administered Units (of Measure)
mLY
Administering Provider
Susan Pike
Y
Administered-at Location
15 Atlantic Avenue, Stamford, CT, 06903
Y
Lot Number
6332FK34
Y
Substance Expiration Date
12/31/2022
Y
Substance Manufacturer Name
GlaxoSmithKline Biologicals SA (MVX SKB)
Y
Completion Status
Completed (CP)
Y
Route of Administration
Intramuscular (NCIT: C28161, HL70162: IM)
Y
Administration Site
Left Thigh (HL70163: LT)
Y

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Mariela
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 202210011100
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country USA
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type CP
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales
PID-5.2 Given Name Juana
PID-5.3 Second and Further Given Names or Initials Thereof Mariela
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 202210011100
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 3321 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 1970230
ORC-3.2 Namespace ID SRH
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SRH
ORC-17.2 Text Stamford Regional Hospital
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221001
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike
RXA-10.3 Given Name Susan
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text Hep B, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text Hep B, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text DTaP, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 152
OBX-5.2 Text Pneumococcal Conjugate, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20240101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20240101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20240401
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20240401
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Juana Mariela Gonzales
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juana Mariela Gonzales
Date of Birth 10/01/2022
Sex Female
Address 1
Street 3321 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Joanna Elena Morales
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Stamford Regional Hospital
Vaccine Group Hep B, unspecified formulation
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 10/01/2022
Date/Time Administration-End 10/01/2022
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name Susan Pike
ID Number
Administered-at Location
Facility ID SRH
Street Address 15 Atlantic Avenue
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Hep B, unspecified formulation
Vaccine Due Date 10/31/2022
Earliest Date to Give 10/31/2022
Latest Date to Give
Date When Vaccine Overdue 01/01/2023
Status in Immunization Series
Forecast Reason
Vaccine Group DTaP, unspecified formulation
Vaccine Due Date 11/30/2022
Earliest Date to Give 11/30/2022
Latest Date to Give
Date When Vaccine Overdue 01/01/2023
Status in Immunization Series
Forecast Reason
Vaccine Group Hib
Vaccine Due Date 11/30/2022
Earliest Date to Give 11/30/2022
Latest Date to Give
Date When Vaccine Overdue 01/01/2023
Status in Immunization Series
Forecast Reason
Vaccine Group IPV
Vaccine Due Date 11/30/2022
Earliest Date to Give 11/30/2022
Latest Date to Give
Date When Vaccine Overdue 01/01/2023
Status in Immunization Series
Forecast Reason
Vaccine Group Pneumococcal Conjugate, unspecified formulation
Vaccine Due Date 11/30/2022
Earliest Date to Give 11/30/2022
Latest Date to Give
Date When Vaccine Overdue 01/01/2023
Status in Immunization Series
Forecast Reason
Vaccine Group rotavirus, unspecified formulation
Vaccine Due Date 11/30/2022
Earliest Date to Give 11/30/2022
Latest Date to Give
Date When Vaccine Overdue 01/01/2023
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2023
Earliest Date to Give 09/01/2023
Latest Date to Give
Date When Vaccine Overdue 01/01/2024
Status in Immunization Series
Forecast Reason
Vaccine Group Hep A, unspecified formulation
Vaccine Due Date 10/01/2023
Earliest Date to Give 10/01/2023
Latest Date to Give
Date When Vaccine Overdue 01/01/2024
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 10/01/2023
Earliest Date to Give 10/01/2023
Latest Date to Give
Date When Vaccine Overdue 04/01/2024
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 10/01/2023
Earliest Date to Give 10/01/2023
Latest Date to Give
Date When Vaccine Overdue 04/01/2024
Status in Immunization Series
Forecast Reason

4.1.4. View the vaccination forecast for Juana Mariela Gonzales

Test Step Type: SUT_MANUAL
The EHR displays the current Immunization Forecast to the user for Juana Mariela Gonzales either as returned by the IIS in prior step, or as generated thru any local means.

Test Story

Description

The physician accesses the record for Juana Mariela Gonzales and:

- Views the vaccine forecast (either as provided by the Immunization Registry or as determined through EHR defined methods).


Comments

No Comments


Pre-condition

EHR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Juana Mariela Gonzales).



Post-Condition

A vaccine forecast based upon the imported vaccine history is available to the user.


Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations.



Evaluation Criteria

1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:

2. Verify that the EHR includes in the vaccine forecast:

Hep B Peds NOS due on 10/31/2022
DTaP due on 11/30/2022
Hib due on 11/30/2022
IPV due on 11/30/2022
Pneumococcal conjugate due on 11/30/2022
Rotavirus due on 11/30/2022
HepA due on 10/1/2023
MMR due on 10/1/2023
Varicella due on 10/1/2023
influenza, unspecified formulation due on Sept 1, 2023 or later

Notes

NOTE: Influenza does not have an overdue date. For DTaP: Catch-up schedule at this age doesn't really have an overdue date; same with HiB; Jan 14, 2023 is latest date to start rotavirus so depends on the date of the test; For these younger children, the EHR may follow a more detailed schedule based on age at the time of the test.  This will result in variation in the forecast for this patient depending upon the date the test is run. Tester should document the rotavirus forecast implemented by the vendor. While there is not an expected  recommendation for the earliest date to give for influenza, this may appear in some EHR implementations. Tester should note if this is included.

The due date must be in range for the date shown. Vaccine forecast dates may be plus or minus 10 days to accommodate differences in date handling.

Further variation should be documented in the notable exceptions, but minimally each forecast vaccine must be present.

 Rotavirus not due after 14 weeks, so depending on when the test is run, this may be due or not due.


4.2. Juana Mariela Gonzales, Enter Orders and Immunizations

Orders and Immunization events, non-administrations, and alerts presented for current visit.

Test Story

Description

This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients.


Comments

No Comments


Pre-condition

Juana Mariela Gonzales is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juana Mariela Gonzales Initial Data Load'.


Post-Condition

Visit orders are entered in Juana Mariela Gonzales' record.


Test Objectives

Supporting data for documenting contraindications (it could also trigger an alert as a locally configured alert rule)

Modify Antigen Recommendations Based on Active Diagnoses: The EHR or other clinical software system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses.

Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed.

Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

  - 2101: Indicates that a contraindication effective date messaged in OBX-5 is in the future


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


4.2.1. Enter Initial Clinical Information for Juana Mariela

Test Step Type: SUT_MANUAL
The EHR captures structured data indicating that Juana Mariela has a fever in the current visit.

Test Story

Description

The triage nurse enters basic information on Juana Mariela Gonzales - she has a fever (Temperature of 100.8 degrees F).


Comments

No comments


Pre-condition

The EHR has recorded all of the pediatric demographic data in the record created for Juana Mariela Gonzales.


Post-Condition

The clinical record for Juana Mariela Gonzales indicates that she currently has a fever (temperature 100.8 degrees F).


Test Objectives

Supporting data for documenting contraindications (it could also trigger an alert as a locally configured alert rule):

Modify Antigen Recommendations Based on Active Diagnoses: The EHR or other clinical software system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient's current or historical diagnoses.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all clinical data provided with all required attributes indicated by [Y]. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

Vital Signs
Fever of 100.8 (@code LOINC 8310-5 @value 100.8)
Vital Signs Observation Date
Date of current visit
Problems (If vendor uses problems for alert computations, then this should be included.)
Problem list: (Low grade pyrexia (finding) 304213008)
Problem Observation Date
Date of current visit

Notes

No Note


4.2.2. Vaccine Deferral Data Quality Checks

Test Step Type: SUT_MANUAL
The provider attempts to document vaccine deferral information for Juana Mariela Gonzales in the EHR. Vaccination deferral data quality checks are verified during data entry.

Test Story

Description

The provider attempts to document vaccine deferral information for the immunization for Juana Mariela Gonzales. These data quality checks primarily relate to improving vaccine deferral information and associated observations that will be included when submitting data to the immunization registry.


Comments

Evaluates EHR functions for verifying data quality of vaccine deferral data and associated observations used for reporting vaccinations to the immunization registry. There is no transaction associated with this test step.


Pre-condition

Prior Immunization History loaded and reconciled from the Immunization Registry. Vaccine forecast is available in the EHR indicating 6 vaccines are due: Hepatitis B, DTaP, Hib, IPV, Pneumococcal conjugate (PCV13) and Rotavirus.



Post-Condition

The EHR has alerted the provider for each of the vaccine deferral data quality checks verified for Juana Mariela Gonzales.


Test Objectives

Data Quality Checks: The EHR or other clinical software integrate additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

  - 2101: Indicates that a contraindication effective date messaged in OBX-5 is in the future


Evaluation Criteria

Evaluation Criteria: During the course of data entry for the variant information below, the EHR triggers the following data quality issues:

  • Triggers Error that a contraindication effective date is in the future (2101):
Entered BY
Sandra Molina

Ordering Provider
Frank Smith

Entering Organization
Shoreline Pediatrics

Vaccine Event information source
New immunization record (NIP001 00)

Value/Text for Vaccine Type
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)


diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)


Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)


poliovirus vaccine (CVX 10)


pneumococcal conjugate vaccine, 13 valent (CVX 133)


rotavirus, live, monovalent vaccine (CVX 119)

Date/Time Vaccine not administered was recorded
Current Date

Alert
contraindication of fever

Substance/Treatment Deferral Start Date: Vaccination contraindication/precaution effective date (30946-8 LOINC)
Current Date+1 day
Triggers Error that a contraindication effective date is in the future  (2101)
Vaccination temporary contraindication/precaution expiration date (Deferred for 1 month)
Current Date + 1month



Notes

The full vaccination deferral details are provided here to facilitate the documentation constraints and/or screens that may be required by the vendor in order to attempt to document the data of interest, but these are not verified until the next step. Only those attributes specified that are anticipated to result in data quality alerts are required for this step.


4.2.3. Enters a medical deferral for the vaccines due

Test Step Type: SUT_MANUAL
Enters a deferral for vaccines due (Hepatitis B, DTaP, Hib, Pneumococcal conjugate (PCV13) and Rotavirus) due to medical reason, indicating low grade fever, and defers for 1 month.

Test Story

Description

The physician accesses the record for Juana Mariela Gonzales and:

- Enters a deferral for the vaccines due (Hepatitis B, DTaP, Hib, Pneumococcal conjugate (PCV13) and Rotavirus) due to medical reason, indicating low grade fever, and defers for 1 month.


Comments

No Comments


Pre-condition

Prior Immunization History loaded and reconciled from the Immunization Registry. Vaccine forecast is available in the EHR indicating 6 vaccines are due: Hepatitis B, DTaP, Hib, IPV, Pneumococcal conjugate (PCV13) and Rotavirus.



Post-Condition

Vaccine deferral is recorded indicating the medical reason of low-grade fever.


Test Objectives

Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed.


Evaluation Criteria

The EHR records the following vaccine administration information. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

Entered BY
Sandra Molina
Ordering Provider
Frank Smith
Entering Organization
Shoreline Pediatrics
Vaccine Event information source
New immunization record (NIP001 00)
Value/Text for Vaccine Type
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)

diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)

Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)

poliovirus vaccine (CVX 10)

pneumococcal conjugate vaccine, 13 valent (CVX 133)

rotavirus, live, monovalent vaccine (CVX 119)
Date/Time Vaccine not administered was recorded
Current Date
Alert
contraindication of fever
Substance/Treatment Deferral Start Date: Vaccination contraindication/precaution effective date (30946-8 LOINC)
Current Date
Vaccination temporary contraindication/precaution expiration date (Deferred for 1 month)
Current Date + 1month



Notes

The EHR does not need to specify a 'new immunization', as long as there is a way to indicate that it is a new immunization within the EHR, this is acceptable (e.g. the default interpretation of the data entry is that it is a new immunization and not historical).


4.3. Juana Mariela Gonzales Transmit Immunization Report

Send the Immunization Report to the Immunization Registry (VXU/Z22) for Juana Mariela Gonzales.

Test Story

Description

Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes deferrals for the vaccines that were due this visit indicating the medical reason. The report MAY send the immunizations that the EHR imported from the IIS.



Comments

No Comments


Pre-condition

The vaccines for the visit have been deferred.


Post-Condition

The IIS has received the vaccine information (Z22 message).


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.

Note: Testing for NDC codes, CVX for immunizations.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


4.3.1. Transmit the Immunization Report for Juana Mariela Gonzales

Test Step Type: SUT_INITIATOR
The EHR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This includes the vaccine deferral and may include historical information updated in the EHR during the visit.

Test Story

Description

Following the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes the vaccine deferrals. The report MAY send the immunizations that the EHR imported from the IIS.


Comments

The Report must include all vaccine deferrals recorded in the EHR in any order. The report may include the information imported from the IIS.


Pre-condition

The vaccines for the visit have been administered.


Post-Condition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.

Note: Testing for NDC codes, CVX for immunizations.



Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. The message must contain all deferrals recorded in the EHR. Current Date is expected for the Non-Administration date and deferral date.


Notes

All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘).


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031001020-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIPEHRFAC Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code XX Presence-Content Indifferent
MSH-22.10 Organization Identifier 100-1 Presence-Content Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIPIISFAC Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code XX Presence-Content Indifferent
MSH-23.10 Organization Identifier 100-2 Presence-Content Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales Value-Test Case Fixed
PID-5.2 Given Name Juana Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Mariela Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Morales Value-Test Case Fixed
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 202210011100 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Value-Test Case Fixed
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 3321 Standish Way Value-Test Case Fixed
PID-11.2 Other Designation
PID-11.3 City Stamford Value-Test Case Fixed
PID-11.4 State or Province CT Value-Test Case Fixed
PID-11.5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type L Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551214 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Value-Test Case Fixed
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator Y Value-Test Case Fixed
PID-25 Birth Order 1 Value-Test Case Fixed
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 03 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - no calls Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20221001
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20221001 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20221001 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Gonzales Value-Test Case Fixed
NK1-2.2 Given Name Joanna Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Elena Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 3321 Standish Way Indifferent
NK1-4.2 Other Designation
NK1-4.3 City Stamford Indifferent
NK1-4.4 State or Province CT Indifferent
NK1-4.5 Zip or Postal Code 06903 Indifferent
NK1-4.6 Country
NK1-4.7 Address Type L Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Indifferent
NK1-5.3 Telecommunication Equipment Type CP Indifferent
NK1-5.4 Email Address
NK1-5.6 Area/City Code 203 Indifferent
NK1-5.7 Local Number 5551214 Indifferent

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 1970230
ORC-3.2 Namespace ID SRH
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Pike
ORC-10.3 Given Name Susan
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Parker
ORC-12.3 Given Name Justin
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SRH
ORC-17.2 Text Stamford Regional Hospital
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221001 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text Hepatitis B Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike Presence-Content Indifferent
RXA-10.3 Given Name Susan
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6332FK34
RXA-16 Substance Expiration Date
RXA-16.1 Time 20221231
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 998 Value-Test Case Fixed
RXA-5.2 Text No vaccine administered Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 998 Value-Test Case Fixed
RXA-5.2 Text No vaccine administered Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 998 Value-Test Case Fixed
RXA-5.2 Text No vaccine administered Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 998 Value-Test Case Fixed
RXA-5.2 Text No vaccine administered Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 998 Value-Test Case Fixed
RXA-5.2 Text No vaccine administered Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text No vaccine administered
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA
RXA-21 Action Code - RXA A

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7 Value-Test Case Fixed
OBX-3.2 Text vaccine type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 08 Indifferent
OBX-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage Presence-Content Indifferent
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC23 Presence-Content Indifferent
OBX-5.2 Text current fever with moderate-to-severe illness
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication/precaution effective date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20211130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7 Value-Test Case Fixed
OBX-3.2 Text vaccine type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 106 Presence-Content Indifferent
OBX-5.2 Text DTaP Presence-Content Indifferent
OBX-5.3 Name of Coding System CVX Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC23 Presence-Content Indifferent
OBX-5.2 Text current fever with moderate-to-severe illness
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication/precaution effective date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20211130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7 Value-Test Case Fixed
OBX-3.2 Text vaccine type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 49 Presence-Content Indifferent
OBX-5.2 Text Hib Presence-Content Indifferent
OBX-5.3 Name of Coding System CVX Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC23 Presence-Content Indifferent
OBX-5.2 Text current fever with moderate-to-severe illness
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication/precaution effective date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20211130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7 Value-Test Case Fixed
OBX-3.2 Text vaccine type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10 Presence-Content Indifferent
OBX-5.2 Text IPV Presence-Content Indifferent
OBX-5.3 Name of Coding System CVX Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC23 Presence-Content Indifferent
OBX-5.2 Text current fever with moderate-to-severe illness
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication/precaution effective date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20211130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7 Value-Test Case Fixed
OBX-3.2 Text vaccine type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 133 Presence-Content Indifferent
OBX-5.2 Text Pneumococcal conjugate (PCV13) Presence-Content Indifferent
OBX-5.3 Name of Coding System CVX Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC23 Presence-Content Indifferent
OBX-5.2 Text current fever with moderate-to-severe illness
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication/precaution effective date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20211130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 119
OBX-5.2 Text Rotavirus
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0
OBX-3.2 Text Vaccination contraindication
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC23
OBX-5.2 Text current fever with moderate-to-severe illness
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8
OBX-3.2 Text Vaccination contraindication/precaution effective date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20211130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juana Mariela Gonzales
Mother's Maiden Name Joanna Morales
ID Number 123456 987633
Date/Time of Birth 10/01/2022 11:00
Administrative Sex Female
Patient Address 3321 Standish Way Stamford CT 06903 USA
Local Number (203)555-1214
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator Yes
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 10/01/2022
Publicity Code Reminder/recall - no calls
Publicity Code Effective Date 10/01/2022
Protection Indicator No
Protection Indicator Effective Date 10/01/2022
Guardian or Responsible Party
Element Data
Name Joanna Elena Gonzales
Relationship Mother
Address 3321 Standish Way Stamford CT 06903
Phone Number (203)555-1214

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis B
Date/Time Start of Administration 10/01/2022
Administered Amount 0.5
Administered Units
Administration Notes
Administering Provider Susan Pike
Substance Lot Number 6332FK34
Substance Expiration Date 12/31/2022
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Stamford Regional Hospital
Entered By Susan Pike
Ordered By Justin Parker

Vaccine Administration Information
Element Data
Administered Vaccine No vaccine administered
Date/Time Start of Administration 10/31/2022
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status Not Administered
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
vaccine type hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 10/31/2022
Vaccination temporary contraindication/precaution expiration date 11/30/2021

Vaccine Administration Information
Element Data
Administered Vaccine No vaccine administered
Date/Time Start of Administration 10/31/2022
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status Not Administered
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
vaccine type DTaP
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 10/31/2022
Vaccination temporary contraindication/precaution expiration date 11/30/2021

Vaccine Administration Information
Element Data
Administered Vaccine No vaccine administered
Date/Time Start of Administration 10/31/2022
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status Not Administered
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
vaccine type Hib
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 10/31/2022
Vaccination temporary contraindication/precaution expiration date 11/30/2021

Vaccine Administration Information
Element Data
Administered Vaccine No vaccine administered
Date/Time Start of Administration 10/31/2022
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status Not Administered
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
vaccine type IPV
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 10/31/2022
Vaccination temporary contraindication/precaution expiration date 11/30/2021

Vaccine Administration Information
Element Data
Administered Vaccine No vaccine administered
Date/Time Start of Administration 10/31/2022
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status Not Administered
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
vaccine type Pneumococcal conjugate (PCV13)
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 10/31/2022
Vaccination temporary contraindication/precaution expiration date 11/30/2021

Vaccine Administration Information
Element Data
Administered Vaccine No vaccine administered
Date/Time Start of Administration 10/31/2022
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status Not Administered
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
vaccine type Rotavirus
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 10/31/2022
Vaccination temporary contraindication/precaution expiration date 11/30/2021

4.3.2. Receive ACK Z23 from Immunization Registry

Test Step Type: TA_RESPONDER
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Test Story

Description

The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.


Comments

No Comments


Pre-condition

A VXU message is generated by the EHR.


Post-Condition

The ACK Z23 is received by the EHR.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.


Evaluation Criteria

The acknowledgement message is consumed by the system responsible for the content of the administration message without error.


Notes

Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031073734.034-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-1.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-AD-1.1_Send_V04_Z22

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5. Juana Maria Gonzales Visit

Infant twin, Juana Maria Gonzales Morales visits the provider where her immunization history is retrieved from the registry and reconciled with the local information in the medical record to determine vaccines that are due. Vaccinations are ordered and administered. The vaccines are reported to the immunization registry and a vaccine summary is available for the patient.

Test Story

Description

Comments

Pre-condition

Post-Condition

Test Objectives

Evaluation Criteria

Notes

5.1. Query the Registry for Juana Maria Gonzales

The EHR generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Maria Gonzales.

Test Story

Description

The EHR generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Maria Gonzales. Querying the registry will consist of the vendor creating Z44 messages for Juana Maria Gonzales to be sent to the registry. The response will be processed as part of the 'Display, Reconcile, Import and Update Immunization Information' activity.

Using the Z42 Response to Immunization Registry Query, the EHR displays the Evaluated History and Forecast to the user for reconciliation and update. The vendor will receive information back from the registry and show the ability to view and reconcile, and import the information returned by the registry (NOTE: the Z42 message will be provided either manually, or as part of the tool). This test will also look at the system's ability to view the forecast returned by the registry and create a new forecast after reconciling the information.



Comments

No Comments


Pre-condition

Juana Mariela Gonzales is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the Juana Mariela Gonzales Initial Data Load.


Post-Condition

A Z44 Query is generated and submitted to the Immunization Registry/Test tool, and a Z42 response is returned.


Test Objectives

Select New Patient: The EHR or other clinical software system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software. This information is crucial for identifying and selecting the correct patient.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules.

 

Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44)  - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

 

Request/Receive Patient Immunization Data and Identify Source: The EHR  or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.

 

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


5.1.1. Select Patient Juana Maria Gonzales

Test Step Type: SUT_MANUAL
Select patient Juana Maria Gonzales, Infant Twin, distinguishing the patient from other patients with similar demographics (twins).

Test Story

Description

Juana Maria Gonzales is selected as the patient and her record is opened in the EHR.


Comments

No Comments


Pre-condition

Juana Maria Gonzales Initial Data Load completed.


Post-Condition

Juana Maria Gonzales is the active working patient in the EHR.


Test Objectives

Select New Patient: The EHR or other clinical software system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software. This information is crucial for identifying and selecting the correct patient.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules.


Evaluation Criteria

Tester shall verify that the product can distinguish Juana Maria Gonzales from similar sounding names and her twin using all of the pediatric demographics:

Patient ID (previously listed as “Medicaid Number”)
Vendor supplied
Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name
Shoreline Pediatrics
Patient ID: Type (e.g., medical record number, IIS ID)
Vendor supplied
Patient Name: First
Juana
Patient Name: Middle
Maria
Patient Name: Last
Gonzales
Patient Date of Birth
10/01/2022
Birth Time
11:15am
Patient Gender (Administrative Sex)
F
Patient Multiple Birth Indicator
Yes
Patient Birth Order
2
Responsible Person Name: First
Joanna
Responsible Person Name: Middle
Elena
Responsible Person Name: Last
Gonzales
Responsible Person Name: Relationship to Patient
Mother
Mother’s Name: First
Joanna
Mother’s Name: Middle
Elena
Mother’s Name: Last
Gonzales
Mother’s Name: Maiden Last
Morales
Patient Address: Street
3321 Standish Way
Patient Address: City
Stamford
Patient Address: State
CT
Patient Address: Country
USA
Patient Address: Zipcode
06903
Race
White
Ethnicity
Hispanic or Latino
Patient Primary Language
English
Patient Telephone Number
(203) 555-1214
Patient Telephone Number Type (e.g., home, cell)
Cell
Patient E-mail Address
None
Publicity Code
Reminder/recall – no calls (03 HL70215)
Publicity Code Effective Date
10/01/2022
Protection Indicator
Yes
Protection Indicator Effective Date
10/01/2022
Immunization Registry Status
Active
Preferred Contact Method
Text

Notes

No Note


5.1.2. Query Registry for vaccination history and forecast too many matches found response

Test Step Type: SUT_INITIATOR
Vendor SHALL be able to Generate a Z44 Query correctly and without omission according to supplied test data.

Test Story

Description

The provider uses the EHR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry. This query will result in an error that too many matches are found.


Comments

While the query is identical, the response to this step will be that no persons are found. No demographic changes are requested for this step as the error trigger is specific to the test step.


Pre-condition

Juana Maria Gonzales Initial Data Load is completed.

Juana Maria Gonzales is the active working patient in the EHR.


Post-Condition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Maria Gonzales.


Test Objectives

Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44)  - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Setup step to test error handling: Test the capability of the EHR to process a response message that returns no persons found and to provide an indication to the end user.


Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EHR and contains all test data attributes supplied.


Notes

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.4 Assigning Authority
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales Value-Test Case Fixed
QPD-4.2 Given Name Juana Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Maria Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales Value-Test Case Fixed
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 202210011115 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country USA
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type CP
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator Y Value-Test Case Fixed
QPD-11 Birth order 2 Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1
RCP-2.2 Units
RCP-2.2.1 Identifier RD
RCP-2.2.2 Text Records
RCP-2.2.3 Name of Coding System HL70126

Test Data Specification

Patient Information
Element Data
Patient Name Juana Maria Gonzales
Mother's Maiden Name Morales
ID Number 123456
Date/Time of Birth 10/01/2022 11:15
Sex Female
Patient Address 3321 Standish Way Stamford CT 06903 USA
Patient Phone (203)555-1214
Birth Indicator Yes
Birth Order 2

5.1.3. Error Handling - Too many matches found

Test Step Type: TA_RESPONDER
The EMR receives a response from the registry query that too many persons are found. The EHR notifies the user/clinician.

Test Story

Description

The EHR processes notifies the user that there were too many matches found in response to the query the Immunization Registry for an Evaluated History and Forecast.


Comments

The sending (querying) system will need to accept a response indicating that too many matches were found.


Pre-condition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR and the response is available in the EHR for reconciliation and import.


Post-Condition

The Immunization Registry responds with a message is indicating too many matches are found. The EHR has notified the user.


Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.

Tests error handling: Test the capability of the EHR to process a response message that returns too many matches found and to provide an indication to the end user.


Evaluation Criteria

The tester verifies that the user/clinician is notified of no match.

The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but too many matching records were found for the person in the query.


Notes

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031145233-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID NIST-IZ-QR-4.2_Response_TM_K11_Z33
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z33
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-3322
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-QR-3.1_Query_Q11_Z44

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag IZ-3.1-2015
QAK-2 Query Response Status TM
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Maria
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 202210011115
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type CP
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator
QPD-11 Birth order

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5.1.4. Query Registry for vaccination history and forecast no persons found response

Test Step Type: SUT_INITIATOR
Vendor SHALL be able to Generate a Z44 Query correctly and without omission according to supplied test data.

Test Story

Description

The provider uses the EHR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry. This query will result in an error that no persons are found.


Comments

This step is a repeat of Step 2: Query Registry for vaccination history and forecast for Juana Maria Gonzales in order to set up the error-checking response for 'No Persons Found'.

While the query is identical, the response to this step will be that no persons are found. No demographic changes are requested for this step as the error trigger is specific to the test step.


Pre-condition

Juana Maria Gonzales Initial Data Load is completed.

Juana Maria Gonzales is the active working patient in the EHR.


Post-Condition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Maria Gonzales.


Test Objectives

Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44)  - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Tests error handling: Test the capability of the EHR to process a response message that returns no persons found and to provide an indication to the end user.


Evaluation Criteria

Tester verifies that the message has been created and submitted in the test plan to trigger the error handling response in the next step.


Notes

Query step is the same as Step 2: Query Registry for vaccination history and forecast for Juana Maria Gonzales. No new requirements tested.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.4 Assigning Authority
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales Value-Test Case Fixed
QPD-4.2 Given Name Juana Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Maria Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales Value-Test Case Fixed
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 202210011115 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country USA
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type CP
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator Y Value-Test Case Fixed
QPD-11 Birth order 2 Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1
RCP-2.2 Units
RCP-2.2.1 Identifier RD
RCP-2.2.2 Text Records
RCP-2.2.3 Name of Coding System HL70126

Test Data Specification

Patient Information
Element Data
Patient Name Juana Maria Gonzales
Mother's Maiden Name Morales
ID Number 123456
Date/Time of Birth 10/01/2022 11:15
Sex Female
Patient Address 3321 Standish Way Stamford CT 06903 USA
Patient Phone (203)555-1214
Birth Indicator Yes
Birth Order 2

5.1.5. Error Handling - No persons found

Test Step Type: TA_RESPONDER
The EHR receives a response from the registry query that no persons are found. The EHR notifies the user/clinician.

Test Story

Description

The EHR processes notifies the user that there were no persons found in response to the query the Immunization Registry for an Evaluated History and Forecast.


Comments

The sending (querying) system will need to accept a response indicating that no matches were found.


Pre-condition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR and the response is available in the EHR for reconciliation and import.


Post-Condition

The Immunization Registry responds with a message is indicating no person record is found. The EHR has notified the user.


Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.

Tests error handling: Test the capability of the EHR to process a response message that returns no persons found and to provide an indication to the end user.


Evaluation Criteria

The tester verifies that the user/clinician is notified of no match.

The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but no matching records were found for the person in the query.


Notes

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID 2.16.840.1.113883.3.72.5.40.3
MSH-3.3 Universal ID Type ISO
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID 2.16.840.1.113883.3.72.5.40.4
MSH-4.3 Universal ID Type ISO
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID 2.16.840.1.113883.3.72.5.40.1
MSH-5.3 Universal ID Type ISO
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID 2.16.840.1.113883.3.72.5.40.2
MSH-6.3 Universal ID Type ISO
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031145233-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID NIST-IZ-QR-3.2_Response_NF_K11_Z33
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z33
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-3322
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-QR-3.1_Query_Q11_Z44

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag IZ-3.1-2015
QAK-2 Query Response Status NF
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Maria
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 202210011115
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator
QPD-11 Birth order

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5.1.6. Query Registry for vaccination history and forecast for Juana Maria Gonzales

Test Step Type: SUT_INITIATOR
Vendor SHALL be able to Generate a Z44 Query correctly and without omission according to supplied test data.

Test Story

Description

The provider uses the EHR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.


Comments

This step is a repeat of Step 2: Query Registry for vaccination history and forecast for Juana Maria Gonzales in order to set up the response for the history and forecast that will be imported in the following step.


Pre-condition

Juana Maria Gonzales Initial Data Load is completed.

Juana Maria Gonzales is the active working patient in the EHR.


Post-Condition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Maria Gonzales.


Test Objectives

Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44)  - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).


Evaluation Criteria

Tester verifies that the message has been created and submitted in the test plan to trigger the error handling response in the next step.


Notes

Query step is the same as Step 2: Query Registry for vaccination history and forecast for Juana Maria Gonzales. No new requirements tested.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.4 Assigning Authority
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales Value-Test Case Fixed
QPD-4.2 Given Name Juana Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Maria Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales Value-Test Case Fixed
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 202210011115 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country USA
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type CP
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator Y Value-Test Case Fixed
QPD-11 Birth order 2 Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1
RCP-2.2 Units
RCP-2.2.1 Identifier RD
RCP-2.2.2 Text Records
RCP-2.2.3 Name of Coding System HL70126

Test Data Specification

Patient Information
Element Data
Patient Name Juana Maria Gonzales
Mother's Maiden Name Morales
ID Number 123456
Date/Time of Birth 10/01/2022 11:15
Sex Female
Patient Address 3321 Standish Way Stamford CT 06903 USA
Patient Phone (203)555-1214
Birth Indicator Yes
Birth Order 2

5.1.7. View and import response to request for vaccination history for Juana Maria Gonzales

Test Step Type: TA_RESPONDER
The EHR displays the Immunization History results (Z42) returned in response to the Z44 Query and import them into the EHR.

Test Story

Description

The physician accesses the record for Juana Maria Gonzales and:

- Accepts the single vaccine in the registry record into the EHR history.


Comments

There is no reconciliation step as there are no historical immunizations in the EHR. All will be imported from the Z42 response.



Pre-condition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR and the response is available in the EHR for reconciliation and import.


Post-Condition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Maria Gonzales).


Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.


Evaluation Criteria


1. The EHR displays the information returned from the Immunization Registry according to the Juror Document.

2. The user imports the vaccination given and the date administered returned from the immunization registry as follows:

Vaccinations Imported:

hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 10/1/2022

Notes

The message returns 'BG2' in the first name of the patient as the first immunization was given at the time of birth before the patient's first name was selected. The EHR should be able to import this record into the patient record despite the apparent name mismatch retaining the original name, Juana Maria Gonzales.

If the EHR is unable to match and import the previous immunization record, they will need to add the following historical immunization manually. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:


Vaccine from Practice HepB


Entered By
Susan Pike
Y
Ordering Provider
Justin Parker
Y
Entering Organization
Stamford Regional Hospital
Y
Administration Notes (Vaccine Event information source)
New immunization record (NIP001 00)
Y
Date/Time of Start of Administration
10/01/2022
Y
Vaccine Administered
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08, NDC 58160-0820-43)
Y
Administered Amount (of Vaccine)
0.5
Y
Administered Units (of Measure)
mL
Y
Administering Provider
Susan Pike
Y
Administered-at Location
15 Atlantic Avenue, Stamford, CT, 06903
Y
Lot Number
6332FK34
Y
Substance Expiration Date
12/31/2022
Y
Substance Manufacturer Name
GlaxoSmithKline Biologicals SA (MVX SKB)
Y
Completion Status
Completed (CP)
Y
Route of Administration
Intramuscular (NCIT: C28161, HL70162: IM)
Y
Administration Site
Left Thigh (HL70163: LT)
Y



Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.4 Assigning Authority
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Maria
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 202210011115
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country USA
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type CP
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator Y
QPD-11 Birth order 2

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Morales
PID-5.2 Given Name BG2
PID-5.3 Second and Further Given Names or Initials Thereof
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 202210011115
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 3321 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 1970230
ORC-3.2 Namespace ID SRH
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier SRH
ORC-17.2 Text Stamford Regional Hospital
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221001
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike
RXA-10.3 Given Name Susan
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text Hep B, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text Hep B, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text DTaP, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 152
OBX-5.2 Text Pneumococcal Conjugate, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20221130
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20240101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20240101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20240401
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20231001
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20240401
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Juana Maria Gonzales
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name BG2 Morales
Date of Birth 10/01/2022
Sex Female
Address 1
Street 3321 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Joanna Elena Morales
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Stamford Regional Hospital
Vaccine Group Hep B, unspecified formulation
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 10/01/2022
Date/Time Administration-End 10/01/2022
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name Susan Pike
ID Number
Administered-at Location
Facility ID SRH
Street Address 15 Atlantic Avenue
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Hep B, unspecified formulation
Vaccine Due Date 10/31/2022
Earliest Date to Give 10/31/2022
Latest Date to Give
Date When Vaccine Overdue 01/01/2023
Status in Immunization Series
Forecast Reason
Vaccine Group DTaP, unspecified formulation
Vaccine Due Date 11/30/2022
Earliest Date to Give 11/30/2022
Latest Date to Give
Date When Vaccine Overdue 01/01/2023
Status in Immunization Series
Forecast Reason
Vaccine Group Hib
Vaccine Due Date 11/30/2022
Earliest Date to Give 11/30/2022
Latest Date to Give
Date When Vaccine Overdue 01/01/2023
Status in Immunization Series
Forecast Reason
Vaccine Group IPV
Vaccine Due Date 11/30/2022
Earliest Date to Give 11/30/2022
Latest Date to Give
Date When Vaccine Overdue 01/01/2023
Status in Immunization Series
Forecast Reason
Vaccine Group Pneumococcal Conjugate, unspecified formulation
Vaccine Due Date 11/30/2022
Earliest Date to Give 11/30/2022
Latest Date to Give
Date When Vaccine Overdue 01/01/2023
Status in Immunization Series
Forecast Reason
Vaccine Group rotavirus, unspecified formulation
Vaccine Due Date 11/30/2022
Earliest Date to Give 11/30/2022
Latest Date to Give
Date When Vaccine Overdue 01/01/2023
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2023
Earliest Date to Give 09/01/2023
Latest Date to Give
Date When Vaccine Overdue 01/01/2024
Status in Immunization Series
Forecast Reason
Vaccine Group Hep A, unspecified formulation
Vaccine Due Date 10/01/2023
Earliest Date to Give 10/01/2023
Latest Date to Give
Date When Vaccine Overdue 01/01/2024
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 10/01/2023
Earliest Date to Give 10/01/2023
Latest Date to Give
Date When Vaccine Overdue 04/01/2024
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 10/01/2023
Earliest Date to Give 10/01/2023
Latest Date to Give
Date When Vaccine Overdue 04/01/2024
Status in Immunization Series
Forecast Reason

5.1.8. View the vaccination forecast for Juana Maria Gonzales

Test Step Type: SUT_MANUAL
The EHR displays the current Immunization Forecast to the user for Juana Maria Gonzales either as returned by the IIS in prior step, or as generated thru any local means.

Test Story

Description

The physician accesses the record for Juana Maria Gonzales and:

- Views the vaccine forecast (either as provided by the Immunization Registry or as determined through EHR defined methods).


Comments

No Comments


Pre-condition

The EHR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Juana Maria Gonzales').



Post-Condition

A vaccine forecast based upon the imported vaccine history is available to the user.



Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations.



Evaluation Criteria

1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:

2. Verify that the EHR includes in the vaccine forecast:


Hep B Peds NOS due on 10/31/2022
DTaP due on 11/30/2022
Hib due on 11/30/2022
IPV due on 11/30/2022
Pneumococcal conjugate due on 11/30/2022
Rotavirus due on 11/30/2022
HepA due on 10/1/2023
MMR due on 10/1/2023
Varicella due on 10/1/2023
influenza, unspecified formulation due on Sept 1, 2023 or later

Notes

NOTE: Influenza does not have an overdue date. For DTaP: catchup schedule at this age doesn't really have an overdue date; same with HiB; Jan 14, 2022 is latest date to start rotavirus so depends on the date of the test; For these younger children, the EHR may follow a more detailed schedule based on age at the time of the test.  This will result in variation in the forecast for this patient depending upon the date the test is run. Tester should document the rotavirus forecast implemented by the vendor. While there is not an expected  recommendation for the earliest date to give for influenza, this may appear in some EHR implementations. Tester should note if this is included.

The due date must be in range for the date shown. Vaccine forecast dates may be plus or minus 10 days to accommodate differences in date handling.

Further variation should be documented in the notable exceptions, but minimally each forecast vaccine must be present.


5.2. Juana Maria Gonzales, Enter Orders and Immunizations

Orders and Immunization events, non-administrations, and alerts presented for current visit.

Test Story

Description

This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients.


Comments

No Comments


Pre-condition

Juana Maria Gonzales is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juana Maria Gonzales Initial Data Load'.


Post-Condition

Visit orders are entered in Juana Maria Gonzales' record.


Test Objectives

Supporting data for error handling tests.

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine).

Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


5.2.1. Record Combo Vaccine administration

Test Step Type: SUT_MANUAL
The EHR is able to document all attributes associated with the new vaccine administration.

Test Story

Description

The nurse administers the DTaP-hepatitis B and poliovirus vaccine:

- Documents all required information for the vaccine.





Comments

No Comments


Pre-condition

Prior Immunization History loaded and reconciled from the Immunization Registry. Vaccine forecast is available in the EHR indicating 6 vaccines are due: Hepatitis B, DtaP, Hib, IPV, Pneumococcal conjugate (PCV13) and Rotavirus.

Order is placed for DTaP-hepatitis B and poliovirus vaccine.



Post-Condition

The DTaP-hepatitis B and poliovirus vaccination is recorded in the EHR.


Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine).


Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS.


Evaluation Criteria

The EHR records the following vaccine administration information. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions.

The EHR records the following vaccine administration information, and using the 2D Barcode found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:

Entered By
Sandra Molina
Ordering Provider
Frank Smith
Entering Organization
Shoreline Pediatrics
Vaccine Event information source
New immunization record (NIP001 00)
Date/Time of Start of Administration
Current Date
Vaccine Administered
DTaP-hepatitis B and poliovirus vaccine (CVX 110)
Pediarix (NDC 58160-0811-43)
2D Barcode
GTIN
10358160811439
Administered Amount (of Vaccine)
0.5
Administered Units (of Measure)
mL
Administration Notes

Administering Provider
Sandra Molina
Administered-at Location
400 Shoreline Drive, Stamford Connecticut 06901
Lot Number
6559FK32
Substance Expiration Date
12/31/2023
Substance Manufacturer Name
GlaxoSmithKline Biologicals SA (MVX SKB)
Completion Status
Completed (CP)
Route of Administration
Intramuscular (NCIT: C28161, HL70162: IM)
Administration Site
Left Deltoid (HL70163: LD)
VFC Eligibility
No
Funding Source
Private
VIS Given Date
Current Date
VIS Fully Encoded Text-String
253088698300026411211015



Notes

The EHR does not need to specify a 'new immunization', as long as there is a way to indicate that it is a new immunization within the EHR, this is acceptable (e.g. the default interpretation of the data entry is that it is a new immunization and not historical).







5.3. Juana Maria Gonzales Transmit Immunization Report - Error Handling

This Test Case verifies the ability of the EHR to handle errors and warnings in response to the Send the Immunization Report to the Immunization Registry (VXU/Z22) transaction for Juana Maria Gonzales.

Test Story

Description

Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report MAY send the immunizations that the EHR imported from the IIS.

This transaction will result in an error or warning from the IIS.


Comments

No Comments


Pre-condition

The vaccines for the visit have been administered.


Post-Condition

The IIS has received the vaccine information (Z22 message) and issued a Z23 response with an error or warning.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

 

Verify that the EHR is able to receive and display the error or warning response from the IIS.

 

Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.

Note: Testing for NDC codes, CVX for immunizations.



Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


5.3.1. Transmit the Immunization Report for Juana Maria Gonzales - Fatal Error Handling

Test Step Type: SUT_INITIATOR
The EHR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This will result in a fatal error from the IIS to assess the EHR ability to receive and display the error.

Test Story

Description

Following the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The report MAY send the immunizations that the EHR imported from the IIS. This will result in a warning from the IIS to assess the EHR ability to receive and display the error.


Comments

The Report must include all vaccine deferrals recorded in the EHR in any order. The report may include the information imported from the IIS.


Pre-condition

The vaccines for the visit have been administered.


Post-Condition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

 

Setup to verify that the EHR is able to receive and display the error response from the IIS.

Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.

Note: Testing for NDC codes, CVX for immunizations.



Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.


Notes

The protection indicator for Juana Maria is 'Yes'. If this setting restricts the EHR from transmitting to the IIS, then the protection indicator for Juana Maria may be modified to 'No' for the purpose of this transaction.

All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘).


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031122240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIPEHRFAC Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code XX Presence-Content Indifferent
MSH-22.10 Organization Identifier 100-1 Presence-Content Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIPIISFAC Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code XX Presence-Content Indifferent
MSH-23.10 Organization Identifier 100-2 Presence-Content Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales Value-Test Case Fixed
PID-5.2 Given Name Juana Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Maria Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Morales Value-Test Case Fixed
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 202210011115 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 3321 Standish Way Value-Test Case Fixed
PID-11.2 Other Designation
PID-11.3 City Stamford Value-Test Case Fixed
PID-11.4 State or Province CT Value-Test Case Fixed
PID-11.5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type L Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551214 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator Y Value-Test Case Fixed
PID-25 Birth Order 2 Value-Test Case Fixed
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 03 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - no calls Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-12 Protection Indicator Y Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20221001 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20221001 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20221001 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Gonzales Value-Test Case Fixed
NK1-2.2 Given Name Joanna Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Elena Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Configuration
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 3321 Standish Way Indifferent
NK1-4.2 Other Designation
NK1-4.3 City Stamford Indifferent
NK1-4.4 State or Province CT Indifferent
NK1-4.5 Zip or Postal Code 06903 Indifferent
NK1-4.6 Country
NK1-4.7 Address Type L Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Indifferent
NK1-5.3 Telecommunication Equipment Type CP Indifferent
NK1-5.4 Email Address
NK1-5.6 Area/City Code 203 Indifferent
NK1-5.7 Local Number 5551214 Indifferent

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 1970230
ORC-3.2 Namespace ID SRH
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Pike Presence-Content Indifferent
ORC-10.3 Given Name Susan Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Parker Indifferent
ORC-12.3 Given Name Justin Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L Indifferent
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SRH Presence-Content Indifferent
ORC-17.2 Text Stamford Regional Hospital Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Value-Test Case Fixed
ORC-10.3 Given Name Sandra Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Value-Test Case Fixed
ORC-12.3 Given Name Frank Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Value-Test Case Fixed
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221001 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text Hepatitis B Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Indifferent
RXA-7 Administered Units
RXA-7.1 Identifier mL Indifferent
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Presence-Content Indifferent
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001 Presence-Configuration
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike Presence-Content Indifferent
RXA-10.3 Given Name Susan Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6332FK34
RXA-16 Substance Expiration Date
RXA-16.1 Time 20221231 Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Indifferent
RXA-17.2 Text GlaxoSmithKline Biologicals SA Indifferent
RXA-17.3 Name of Coding System MVX Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 110 Value-Test Case Fixed
RXA-5.2 Text DTaP-HepB-IPV Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Presence-Content Indifferent
RXA-10.3 Given Name Sandra Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6559FK32 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20231231 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Biologicals SA Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Indifferent
RXR-1.2 Text Intramuscular Indifferent
RXR-1.3 Name of Coding System NCIT Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier LT Indifferent
RXR-2.2 Text Left Thigh Indifferent
RXR-2.3 Name of Coding System HL70163 Indifferent

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300026411211015 Presence-Content Indifferent
OBX-5.2 Text Multiple Vaccines VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text VIS Presentation Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier V01 Presence-Content Indifferent
OBX-5.2 Text Not VFC eligible
OBX-5.3 Name of Coding System HL70064 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier PHC70 Value-Test Case Fixed
OBX-5.2 Text Private Presence-Content Indifferent
OBX-5.3 Name of Coding System CDCPHINVS Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juana Maria Gonzales
Mother's Maiden Name Joanna Morales
ID Number 123456 987633
Date/Time of Birth 10/01/2022 11:15
Administrative Sex Female
Patient Address 3321 Standish Way Stamford CT 06903 USA
Local Number (203)555-1214
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator Yes
Birth Order 2
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 10/01/2022
Publicity Code Reminder/recall - no calls
Publicity Code Effective Date 10/01/2022
Protection Indicator Yes
Protection Indicator Effective Date 10/01/2022
Guardian or Responsible Party
Element Data
Name Joanna Elena Gonzales
Relationship Mother
Address 3321 Standish Way Stamford CT 06903
Phone Number (203)555-1214

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis B
Date/Time Start of Administration 10/01/2022
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider Susan Pike
Substance Lot Number 6332FK34
Substance Expiration Date 12/31/2022
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Stamford Regional Hospital
Entered By Susan Pike
Ordered By Justin Parker

Vaccine Administration Information
Element Data
Administered Vaccine DTaP-HepB-IPV
Date/Time Start of Administration 10/31/2022
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 6559FK32
Substance Expiration Date 12/31/2023
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Document Type Multiple Vaccines VIS
VIS Presentation Date 10/31/2022
vaccine fund pgm elig cat Not VFC eligible
Vaccine funding source Private

5.3.2. Receive ACK Z23 Fatal Error - CVX Code

Test Step Type: TA_RESPONDER
The Immunization Registry returns a fatal error message indicating a table mapping error for the CVX code submitted was found during the course of filing the message.

Test Story

Description

The Immunization Registry returns a fatal error message indicating a table mapping error for the CVX code submitted was found during the course of filing the message.


Comments

No Comments


Pre-condition

A VXU message is generated by the EHR.


Post-Condition

The ACK Z23 is received by the EHR.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

 

Error Handling Support for a fatal error returned by the IIS, and the ability of the EHR to display a notification of this error to the user.


Evaluation Criteria

The acknowledgement error message is consumed by the system responsible for the content of the administration message.

The error returned is visible in the EHR.


Notes

Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031121047.853-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-7.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-3322
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AE
MSA-2 Message Control ID NIST-IZ-AD-7.1_Send_V04_Z22

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXA
ERR-2.2 Segment Sequence 1
ERR-2.3 Field Position 5
ERR-2.4 Field Repetition 1
ERR-2.5 Component Number 1
ERR-2.6 Sub-Component Number
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999
ERR-3.2 Text Application error
ERR-3.3 Name of Coding System HL70357
ERR-4 Severity E
ERR-5 Application Error Code
ERR-5.1 Identifier 5
ERR-5.2 Text Table value not found
ERR-5.3 Name of Coding System HL70533
ERR-8 User Message Vaccine code not recognized - message rejected

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5.3.3. Transmit the Immunization Report for Juana Maria Gonzales - warning handling

Test Step Type: SUT_INITIATOR
The EHR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This will result in a warning from the IIS to assess the EHR ability to receive and display the warning.

Test Story

Description

Following the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. This will result in multiple warnings from the IIS to assess the EHR ability to receive and display the error.


Comments

The Report must include the newly administered vaccine recorded in the EHR. The report may include the information imported from the IIS.


Pre-condition

The vaccines for the visit have been administered.


Post-Condition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

 

Set up to verify that the EHR is able to receive and display the multiple warning response from the IIS.

Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.

Note: Testing for NDC codes, CVX for immunizations.



Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.


Notes

The protection indicator for Juana Maria is 'Yes'. If this setting restricts the EHR from transmitting to the IIS, then the protection indicator for Juana Maria may be modified to 'No' for the purpose of this transaction.

All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘).


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031122240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIPEHRFAC Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code XX Presence-Content Indifferent
MSH-22.10 Organization Identifier 100-1 Presence-Content Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIPIISFAC Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code XX Presence-Content Indifferent
MSH-23.10 Organization Identifier 100-2 Presence-Content Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales Value-Test Case Fixed
PID-5.2 Given Name Juana Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Maria Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Morales Presence-Content Indifferent
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 202210011115 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 3321 Standish Way Value-Test Case Fixed
PID-11.2 Other Designation
PID-11.3 City Stamford Value-Test Case Fixed
PID-11.4 State or Province CT Value-Test Case Fixed
PID-11.5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type L Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551214 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator Y Value-Test Case Fixed
PID-25 Birth Order 2 Value-Test Case Fixed
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 03 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - no calls Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-12 Protection Indicator Y Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20221001 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20221001 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20221001 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Gonzales Value-Test Case Fixed
NK1-2.2 Given Name Joanna Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Elena Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Configuration
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 3321 Standish Way Indifferent
NK1-4.2 Other Designation
NK1-4.3 City Stamford Indifferent
NK1-4.4 State or Province CT Indifferent
NK1-4.5 Zip or Postal Code 06903 Indifferent
NK1-4.6 Country
NK1-4.7 Address Type L Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Indifferent
NK1-5.3 Telecommunication Equipment Type CP Indifferent
NK1-5.4 Email Address
NK1-5.6 Area/City Code 203 Indifferent
NK1-5.7 Local Number 5551214 Indifferent

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 1970230
ORC-3.2 Namespace ID SRH
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Pike Presence-Content Indifferent
ORC-10.3 Given Name Susan Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Parker Indifferent
ORC-12.3 Given Name Justin Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L Indifferent
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SRH Presence-Content Indifferent
ORC-17.2 Text Stamford Regional Hospital Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Value-Test Case Fixed
ORC-10.3 Given Name Sandra Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Value-Test Case Fixed
ORC-12.3 Given Name Frank Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Value-Test Case Fixed
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221001 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text Hepatitis B Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Indifferent
RXA-7 Administered Units
RXA-7.1 Identifier mL Indifferent
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Presence-Content Indifferent
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001 Presence-Configuration
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike Indifferent
RXA-10.3 Given Name Susan Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6332FK34
RXA-16 Substance Expiration Date
RXA-16.1 Time 20221231 Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Indifferent
RXA-17.2 Text GlaxoSmithKline Biologicals SA Indifferent
RXA-17.3 Name of Coding System MVX Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 110 Value-Test Case Fixed
RXA-5.2 Text DTaP-HepB-IPV Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Value-Test Case Fixed
RXA-10.3 Given Name Sandra Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6559FK32 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20231231 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Biologicals SA Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Indifferent
RXR-1.2 Text Intramuscular Indifferent
RXR-1.3 Name of Coding System NCIT Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier LT Indifferent
RXR-2.2 Text Left Thigh Indifferent
RXR-2.3 Name of Coding System HL70163 Indifferent

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300026411211015 Presence-Content Indifferent
OBX-5.2 Text Multiple Vaccines VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text VIS Presentation Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier V01 Presence-Content Indifferent
OBX-5.2 Text Not VFC eligible
OBX-5.3 Name of Coding System HL70064 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier PHC70 Value-Test Case Fixed
OBX-5.2 Text Private Presence-Content Indifferent
OBX-5.3 Name of Coding System CDCPHINVS Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juana Maria Gonzales
Mother's Maiden Name Joanna Morales
ID Number 123456 987633
Date/Time of Birth 10/01/2022 11:15
Administrative Sex Female
Patient Address 3321 Standish Way Stamford CT 06903 USA
Local Number (203)555-1214
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator Yes
Birth Order 2
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 10/01/2022
Publicity Code Reminder/recall - no calls
Publicity Code Effective Date 10/01/2022
Protection Indicator Yes
Protection Indicator Effective Date 10/01/2022
Guardian or Responsible Party
Element Data
Name Joanna Elena Gonzales
Relationship Mother
Address 3321 Standish Way Stamford CT 06903
Phone Number (203)555-1214

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis B
Date/Time Start of Administration 10/01/2022
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider Susan Pike
Substance Lot Number 6332FK34
Substance Expiration Date 12/31/2022
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Stamford Regional Hospital
Entered By Susan Pike
Ordered By Justin Parker

Vaccine Administration Information
Element Data
Administered Vaccine DTaP-HepB-IPV
Date/Time Start of Administration 10/31/2022
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 6559FK32
Substance Expiration Date 12/31/2023
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Document Type Multiple Vaccines VIS
VIS Presentation Date 10/31/2022
vaccine fund pgm elig cat Not VFC eligible
Vaccine funding source Private

5.3.4. Receive ACK Z23 Warning - Invalid Value

Test Step Type: TA_RESPONDER
The Immunization Registry returns a warning message indicating an invalid administration site code submitted was found during the course of filing the message.

Test Story

Description

The Immunization Registry returns a warning message indicating an unrecognized administration site code submitted was found during the course of filing the message.



Comments

No Comments


Pre-condition

A VXU message is generated by the EHR.


Post-Condition

The ACK Z23 is received by the EHR.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

 

Error Handling Support for a warning returned by the IIS, and the ability of the EHR to display a notification of this warning to the user.


Evaluation Criteria

The acknowledgement warning message is consumed by the system responsible for the content of the administration message.

The warning returned is visible in the EHR.


Notes

Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID 2.16.840.1.113883.3.72.5.40.3
MSH-3.3 Universal ID Type ISO
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID 2.16.840.1.113883.3.72.5.40.4
MSH-4.3 Universal ID Type ISO
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID 2.16.840.1.113883.3.72.5.40.1
MSH-5.3 Universal ID Type ISO
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID 2.16.840.1.113883.3.72.5.40.2
MSH-6.3 Universal ID Type ISO
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031103328.758-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-8.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-3322
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AE
MSA-2 Message Control ID NIST-IZ-AD-8.1_Send_V04_Z22

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXR
ERR-2.2 Segment Sequence 2
ERR-2.3 Field Position 1
ERR-2.4 Field Repetition 1
ERR-2.5 Component Number 1
ERR-2.6 Sub-Component Number
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999
ERR-3.2 Text Application error
ERR-3.3 Name of Coding System HL70357
ERR-4 Severity W
ERR-5 Application Error Code
ERR-5.1 Identifier 5
ERR-5.2 Text Table value not found
ERR-5.3 Name of Coding System HL70533
ERR-8 User Message Administration Site not recognized - site data will not be saved

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5.3.5. Transmit the Immunization Report for Juana Maria Gonzales - Multiple warning handling

Test Step Type: SUT_INITIATOR
The EHR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This will result in multiple warnings from the IIS to assess the EHR ability to receive and display the warnings.

Test Story

Description

Following the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. This will result in multiple warnings from the IIS to assess the EHR ability to receive and display the warnings.


Comments

The Report must include the newly administered vaccine recorded in the EHR. The report may include the information imported from the IIS.


Pre-condition

The vaccines for the visit have been administered.


Post-Condition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

 

Set up to verify that the EHR is able to receive and display the multiple warning response from the IIS.

Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.

Note: Testing for NDC codes, CVX for immunizations.



Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.


Notes

The protection indicator for Juana Maria is 'Yes'. If this setting restricts the EHR from transmitting to the IIS, then the protection indicator for Juana Maria may be modified to 'No' for the purpose of this transaction.

All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘).


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031122240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIPEHRFAC Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code XX Presence-Content Indifferent
MSH-22.10 Organization Identifier 100-1 Presence-Content Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIPIISFAC Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code XX Presence-Content Indifferent
MSH-23.10 Organization Identifier 100-2 Presence-Content Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales Value-Test Case Fixed
PID-5.2 Given Name Juana Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Maria Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Morales Presence-Content Indifferent
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 202210011115 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 3321 Standish Way Value-Test Case Fixed
PID-11.2 Other Designation
PID-11.3 City Stamford Value-Test Case Fixed
PID-11.4 State or Province CT Value-Test Case Fixed
PID-11.5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type L Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551214 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator Y Value-Test Case Fixed
PID-25 Birth Order 2 Value-Test Case Fixed
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 03 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - no calls Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-12 Protection Indicator Y Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20221001 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20221001 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20221001 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Gonzales Value-Test Case Fixed
NK1-2.2 Given Name Joanna Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Elena Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Configuration
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 3321 Standish Way Indifferent
NK1-4.2 Other Designation
NK1-4.3 City Stamford Indifferent
NK1-4.4 State or Province CT Indifferent
NK1-4.5 Zip or Postal Code 06903 Indifferent
NK1-4.6 Country
NK1-4.7 Address Type L Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Indifferent
NK1-5.3 Telecommunication Equipment Type CP Indifferent
NK1-5.4 Email Address
NK1-5.6 Area/City Code 203 Indifferent
NK1-5.7 Local Number 5551214 Indifferent

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 1970230
ORC-3.2 Namespace ID SRH
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Pike Presence-Content Indifferent
ORC-10.3 Given Name Susan Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Parker Indifferent
ORC-12.3 Given Name Justin Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L Indifferent
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SRH Presence-Content Indifferent
ORC-17.2 Text Stamford Regional Hospital Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID SP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Value-Test Case Fixed
ORC-10.3 Given Name Sandra Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Value-Test Case Fixed
ORC-12.3 Given Name Frank Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP Presence-Content Indifferent
ORC-17.2 Text Shoreline Pediatrics Value-Test Case Fixed
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221001 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text Hepatitis B Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Indifferent
RXA-7 Administered Units
RXA-7.1 Identifier mL Indifferent
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 08 Presence-Content Indifferent
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001 Presence-Configuration
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike Indifferent
RXA-10.3 Given Name Susan Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6332FK34
RXA-16 Substance Expiration Date
RXA-16.1 Time 20221231 Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Indifferent
RXA-17.2 Text GlaxoSmithKline Biologicals SA Indifferent
RXA-17.3 Name of Coding System MVX Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 110 Value-Test Case Fixed
RXA-5.2 Text DTaP-HepB-IPV Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Value-Test Case Fixed
RXA-10.3 Given Name Sandra Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6559FK32 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20231231 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Biologicals SA Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Indifferent
RXR-1.2 Text Intramuscular Indifferent
RXR-1.3 Name of Coding System NCIT Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier LT Indifferent
RXR-2.2 Text Left Thigh Indifferent
RXR-2.3 Name of Coding System HL70163 Indifferent

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300026411211015 Presence-Content Indifferent
OBX-5.2 Text Multiple Vaccines VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text VIS Presentation Date Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier V01 Presence-Content Indifferent
OBX-5.2 Text Not VFC eligible
OBX-5.3 Name of Coding System HL70064 Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier PHC70 Value-Test Case Fixed
OBX-5.2 Text Private Presence-Content Indifferent
OBX-5.3 Name of Coding System CDCPHINVS Value-Test Case Fixed
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F Value-Test Case Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juana Maria Gonzales
Mother's Maiden Name Joanna Morales
ID Number 123456 987633
Date/Time of Birth 10/01/2022 11:15
Administrative Sex Female
Patient Address 3321 Standish Way Stamford CT 06903 USA
Local Number (203)555-1214
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator Yes
Birth Order 2
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 10/01/2022
Publicity Code Reminder/recall - no calls
Publicity Code Effective Date 10/01/2022
Protection Indicator Yes
Protection Indicator Effective Date 10/01/2022
Guardian or Responsible Party
Element Data
Name Joanna Elena Gonzales
Relationship Mother
Address 3321 Standish Way Stamford CT 06903
Phone Number (203)555-1214

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine Hepatitis B
Date/Time Start of Administration 10/01/2022
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from public agency
Administering Provider Susan Pike
Substance Lot Number 6332FK34
Substance Expiration Date 12/31/2022
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization Stamford Regional Hospital
Entered By Susan Pike
Ordered By Justin Parker

Vaccine Administration Information
Element Data
Administered Vaccine DTaP-HepB-IPV
Date/Time Start of Administration 10/31/2022
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 6559FK32
Substance Expiration Date 12/31/2023
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Document Type Multiple Vaccines VIS
VIS Presentation Date 10/31/2022
vaccine fund pgm elig cat Not VFC eligible
Vaccine funding source Private

5.3.6. Receive ACK Z23 Multiple Warnings

Test Step Type: TA_RESPONDER
The Immunization Registry returns a message with multiple warnings for invalid administration site codes submitted found during the course of filing the message.

Test Story

Description

The Immunization Registry returns a message with multiple warnings indicating unrecognized administration site codes submitted were found during the course of filing the message.



Comments

No Comments


Pre-condition

A VXU message is generated by the EHR.


Post-Condition

The ACK Z23 is received by the EHR.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

 

Error Handling Support for multiple warnings returned by the IIS, and the ability of the EHR to display a notification of these warnings to the user.


Evaluation Criteria

The acknowledgement warning message is consumed by the system responsible for the content of the administration message.

The multiple warnings returned is visible in the EHR.


Notes

Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031115038.044-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-9.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AE
MSA-2 Message Control ID NIST-IZ-AD-9.1_Send_V04_Z22

ERR[*]
ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXR
ERR-2.2 Segment Sequence 1
ERR-2.3 Field Position 2
ERR-2.4 Field Repetition 1
ERR-2.5 Component Number 1
ERR-2.6 Sub-Component Number
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999
ERR-3.2 Text Application error
ERR-3.3 Name of Coding System HL70357
ERR-4 Severity W
ERR-5 Application Error Code
ERR-5.1 Identifier 5
ERR-5.2 Text Table value not found
ERR-5.3 Name of Coding System HL70533
ERR-8 User Message Administration Site not recognized - site data will not be saved

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXR
ERR-2.2 Segment Sequence 2
ERR-2.3 Field Position 2
ERR-2.4 Field Repetition 1
ERR-2.5 Component Number 1
ERR-2.6 Sub-Component Number
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999
ERR-3.2 Text Application error
ERR-3.3 Name of Coding System HL70357
ERR-4 Severity W
ERR-5 Application Error Code
ERR-5.1 Identifier 5
ERR-5.2 Text Table value not found
ERR-5.3 Name of Coding System HL70533
ERR-8 User Message Administration Site not recognized - site data will not be saved

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

6. Reporting

These tests will include generation of cohort reports and acknowledgement error reports.

Test Story

Description

Comments

Pre-condition

Post-Condition

Test Objectives

Evaluation Criteria

Notes

6.1. Due and Overdue Immunizations

List all patients who are due or overdue for immunizations showing all overdue immunizations. This test will consist of generating a cohort report to list all patients who are due or overdue for immunizations showing all overdue immunizations with the associated due/overdue dates

Test Story

Description

The provider periodically uses the EHR to identify the cohort of patients that are due or overdue for immunizations along with their contact information in order to send reminder notifications to the patients/parents.


Comments

No Comments


Pre-condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. The vaccine forecast is available to the EHR.


Post-Condition

The Cohort report for all patients that are due or overdue for immunizations is available to the provider through the EHR.


Test Objectives

Produce Population-Level Report: The EHR or other clinical software system generates aggregate, population-level reports based on known patient immunization data.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


6.1.1. Produce Overdue Immunizations Cohort Report

Test Step Type: SUT_MANUAL
The provider uses the EHR to create a report for all patient vaccinations overdue with the contact information.

Test Story

Description

The provider periodically uses the EHR to identify the cohort of patients that are due or overdue for immunizations along with their contact information in order to send reminder notifications to the patients/parents.


Comments

No Comments


Pre-condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EHR. The vaccine forecast is available to the EHR. Vaccines administered throughout this test plan.



Post-Condition

The Cohort report for all patients that are due or overdue for immunizations is available to the provider through the EHR for Vaccines administered throughout this test plan.


Test Objectives

Produce Population-Level Report: The EHR or other clinical software system generates aggregate, population-level reports based on known patient immunization data.


Evaluation Criteria

The following patient information is provided on the cohort report:

Patient Name
Juana Mariana Vazquez
Preferred Contact Method
Phone
Contact information using preferred contact (email, text, phone, mailing address)
(203) 555-1212
Patient Identifier Number
Vendor Supplied
Patient Identifier Type Code
Vendor Supplied
Date/Time of Birth
11/1/2017 11:05am
Sex
Female
Vaccine Group
IPV
Due Date
10/31/2021
Overdue Date
10/31/2023
Dose #
4
Dose in Series
4
Vaccine Group
Varicella
Due Date
10/31/2021
Overdue Date
10/31/2023
Dose #
2
Dose in Series
2
Link to full record
Vendor Supplied



Patient Name
Juana Mariela Gonzales
Preferred Contact Method
Text
Contact information using preferred contact (email, text, phone, mailing address)
(203) 555-1214
Patient Identifier Number
Vendor Supplied
Patient Identifier Type Code
Vendor Supplied
Date/Time of Birth
10/1/2022 11am
Sex
Female
Vaccine Group
Hep B Peds NOS
Due Date
10/31/2022
Overdue Date
1/1/2023
Dose #
2
Dose in Series
3
Vaccine Group
DTaP
Due Date
11/30/2022
Dose #
1
Dose in Series
5
Vaccine Group
Hib
Due Date
11/30/2022
Dose #
1
Dose in Series
4
Vaccine Group
IPV
Due Date
11/30/2022
Dose #
1
Dose in Series
4
Vaccine Group
Pneumococcal conjugate
Due Date
11/30/2022
Dose #
1
Dose in Series
4
Link to full record
Vendor Supplied
Vaccine Group
Rotavirus
Due Date
11/30/2022
Dose #
1
Dose in Series
4
Link to full record
Vendor Supplied


Patient Name
Juana Maria Gonzales
Preferred Contact Method
Text
Contact information using preferred contact (email, text, phone, mailing address)
(203) 555-1214
Patient Identifier Number
Vendor Supplied
Patient Identifier Type Code
Vendor Supplied
Date/Time of Birth
10/1/2022 11:15am
Sex
Female
Vaccine Group
Hib
Due Date
11/30/2022
Dose #
1
Dose in Series
4
Vaccine Group
Pneumococcal conjugate
Due Date
11/30/2022
Dose #s
1
Dose in Series
4
Vaccine Group
Rotavirus
Due Date
11/30/2022
Dose #
1
Dose in Series
4
Link to full record
Vendor Supplied
Link to full record
Vendor Supplied




Notes

The vaccines due for the infants, in particular, may vary depending upon when the test is run as they may be subject to variation in the due dates as part of a catch-up schedule. Tester should document any such variances.

Vaccines due for adult patient, Anita Francesca Marina are not required to be included in this report.


6.2. Acknowledgment Error Reporting

Generate a report of all acknowledgment errors, either as a reporting function within the EHR or other clinical system, or as an export for processing in a reporting tool.

Test Story

Description

The EHR has received acknowledgment errors for vaccinations submitted to the IIS. The provider staff  uses the EHR to generate an Acknowledgment Error Report or to export the information for use in a reporting tool.


Comments

No Comments


Pre-condition

The EHR or other clinical software system has received acknowledgement errors from an IIS.


Post-Condition

An acknowledgement report is generated from the EHR or other clinical software system or the report data has been exported to a reporting tool.


Test Objectives

Acknowledgment Data Reporting: The EHR or other clinical software system is able to generate an Aggregate Error Report using the acknowledgment error message data returned in the ACK response to a vaccine update message (VXU/Z22). The report data must include the following data elements:

  • Clinic code and name
  • Patient identifier
  • Vaccination date
  • IIS error severity
  • IIS error code and description

 The aggregate report functionality should include grouping and sorting by error code, clinic, and vaccination date. Drill-down capability by error or date should also be supported as it is important to support identifying the source of the data errors and to correct the issue.



Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


6.2.1. Produce Acknowledgments Report

Test Step Type: SUT_MANUAL
An EHR user is able to create a report that aggregates fatal errors reported in acknowledgment messages from the IIS

Test Story

Description

The provider has received acknowledgment errors for vaccinations submitted to the IIS. The provider staff uses the EHR to generate an Acknowledgment Error Report or to export the information for use in a reporting tool


Comments

In addition to the acknowledgement data received during the course of this test plan, additional acknowledgement errors are provided in this test step.


Pre-condition

The EHR or other clinical software system has received acknowledgement errors from an IIS.



Post-Condition

An acknowledgement report is generated from the EHR or other clinical software system or the report data has been exported to a reporting tool.


Test Objectives

Acknowledgment Data Reporting: The EHR or other clinical software system is able to generate an Aggregate Error Report using the acknowledgment error message data returned in the ACK response to a vaccine update message (VXU/Z22). The report data must include the following data elements:

  • Clinic code and name
  • Patient identifier
  • Vaccination date
  • IIS error severity
  • IIS error code and description

 The aggregate report functionality should include grouping and sorting by error code, clinic, and vaccination date. Drill-down capability by error or date should also be supported as it is important to support identifying the source of the data errors and to correct the issue.



Evaluation Criteria

The EHR or other clinical software is able to generate an Aggregate Error Report using the acknowledgement error message data returned in the ACK response to a vaccine update message (VXU/Z22). The export data must include the following data elements:

  • clinic code and name,
  • patient medical record number,
  • vaccination date,
  • IIS error severity,
  • IIS error code and description, and
  • vaccine type. 

The aggregate report functionality should include grouping and sorting by error code, clinic, vaccination date, and vaccine type. Drill-down capability by error or date should also be supported as it is important to support identifying the source of the data errors and to correct the issue.

This functionality may be accomplished either by leveraging reporting functionality to produce an Aggregate Error Report provided by the EMR or other clinical software system or, as an alternative to the creation of an Aggregate Error Report, the EHR or other clinical software system have the option to allow ACK data to be exported as described in the IIP Aggregate Immunization Acknowledgment Message Reports Guidance White Paper1:

Software developers who do not intend to incorporate aggregate acknowledgment report functionality must be able to support ACK data export functionality. This allows ACK messages received from an IIS to be downloaded in a common electronic format, including raw HL7, which can also be accessed by data analysts and/or third-party tools. The export functionality should allow the user to select a specified period and could have additional filtering capabilities.





Notes

Developers should note which requirement is selected and need not demonstrate both requirements (capabilities). Whichever requirement is selected will be noted if a product achieves IIP recognition.

For the 2021-2022 year this capability is considered “discovery” and is not required.

Developers will be requested to walk through desktop testing to identify current or prospective approaches. They will demonstrate the capability if the functionality exists.  The HIMSS IIP observer will record the process to evaluate whether this capability should be included in future testing.


7. Anita Francesca Marina Visit

Anita Francesca Marina works as a CNA, and is identified as a high-priority candidate for a new adult vaccine. She makes an appointment for the vaccination clinic where she will receive the vaccination. The provider identifies the list of patients that will be vaccinated the following day and requests the patient history from the registry. Anita is one of these patients. Her immunization history is retrieved from the registry and reconciled with the local information in the medical record to determine vaccines that are due. Vaccinations are ordered and administered. The vaccines are reported to the immunization registry and a vaccine summary is available for the patient.

Test Story

Description

Comments

Pre-condition

Post-Condition

Test Objectives

Evaluation Criteria

Notes

7.1. Notify Patients of Immunization Status

Patients are identified that are high-priority candidates for a new adult vaccine campaign. The patients are notified. Anita Francesca Marina is one of these candidates.

Test Story

Description

The EHR is used to identify patients that are high-priority candidates for a new adult vaccine campaign due to their status as a healthcare worker. The EHR is used to notify patients. Anita Francesca Marina is one of these candidates.


Comments

No Comments


Pre-condition

Anita Francesca Marina is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Social History Data according to the steps in the Anita Francesca Marina Initial Data Load.


Post-Condition

Anita has received notification of the vaccine eligibility.


Test Objectives

Notify Patients of Immunization Status: The EHR or other clinical software provides the ability to notify patients of recommendations based on their individual preferences for receiving notification.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


7.1.1. Notify New Vaccine Candidate Patients

Test Step Type: SUT_MANUAL
The provider uses the EHR to create a report for all patients that work in the healthcare industry for a vaccine campaign for a newly available vaccine.

Test Story

Description

The provider is able to use the EHR to identify the cohort of patients that work in the healthcare industry that are prioritized for a newly available vaccine.


Comments

No Comments


Pre-condition

Initial Adult patient data load completed with demographic data, vaccination history, and social history. Historical Vaccination reconciled and loaded into the EHR.


Post-Condition

The list of patients that work in the healthcare industry are identified as candidates for the new vaccine campaign.


Test Objectives

Notify Patients of Immunization Status: The EHR or other clinical software provides the ability to notify patients of recommendations based on their individual preferences for receiving notification.


Evaluation Criteria

The EHR identifies the following patients with documented occupation/industry information that indicate that they work in healthcare, and sends notification that they are a candidate for the new vaccine using their established preferred contact method, for those that have agreed to be contacted per the Publicity Code recorded for the patient.

Patient Name
Anita Francesca Marina
Preferred Contact Method
email
Contact information using preferred contact (email, text, phone, mailing address)
Email provided for Anita Francesca Marina
Patient Identifier Number
Vendor Supplied
Patient Identifier Type Code
Vendor Supplied
Date/Time of Birth
06/01/1997
Sex
Female
Publicity Code
Reminder/recall – any method (02 HL70215)
Publicity Code Effective Date
10/01/2013

Notes

If the EHR is not able to select based on Occupation or Industry, they may select by employer. The tester will document any variation needed to establish this notification.

If there are additional patients in the EHR database that are healthcare workers, they may also appear in this list.


7.2. Query the Registry for Anita Francesca Marina

The EHR allows the provider to select the patients that will be seen in the clinic for the day. Generates a Z44 query to the Immunization Registry to retrieve the patients to be seen in the clinic for the day. Anita Francesca Marina is among these patients, and her vaccine history and recommend vaccinations will be retrieved from the registry for review and reconciliation in the EHR to inform the provider’s vaccination decisions

Test Story

Description

The EHR allows the provider to select the patients that will be seen in the clinic for the day.  Anita Francesca Marina is one of these patients, and a query will be sent to the registry to retrieve her vaccine history.

Querying the registry will consist of the vendor creating a Z44 message for Anita Francesca Marina.

                                                                

Using the Z42 Response to Immunization Registry Query, the EHR displays the Evaluated History and Forecast to the user for reconciliation and update. The vendor will receive information back from the registry and show the ability to view and reconcile, and import the information returned by the registry. This test will also look at the system's ability to view the vaccine recommendation returned by the registry and create a new recommendation after reconciling the information.


Comments

No Comments


Pre-condition

Anita Francesca Marina is entered as a patient in the EHR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the Anita Francesca Marina Initial Data Load.


Post-Condition

A Z44 Query is generated and submitted to the Immunization Registry/Test tool, and a Z42 response is returned.


Test Objectives

Select One or More Patients: The EHR or other clinical software system must allow a provider to specify one or more patients in real time or those scheduled for appointment(s) in the future (e.g., the next day, week, month, etc.) so that a request can be sent to the public health immunization registry for each patient’s complete immunization history.

Select New Patient: The EHR or other clinical software system must allow a user to distinguish information about patients with similar names or identifying information in order to select the right patient from the providers’ EHR or other clinical software. This information is crucial for identifying and selecting the correct patient.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar sounding names. In order to match patients with those already in the immunization registry, the EHR or other clinical software should have the ability to record the mother’s maiden name, whether the patient was part of a multiple birth, and if so, the order of birth (when such information is available). The provider should be aware of how often the protection indicator information must be updated based on local rules.

 Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44)  - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

 Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.

 View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations.

Review Patient Immunization History: The EHR or other clinical software system displays vaccine history by vaccine series.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


7.2.1. Select the Set of Patients to be Seen in the Vaccination Clinic

Test Step Type: SUT_MANUAL
The EHR allows the provider to select the patients that will be seen in the clinic for the day.

Test Story

Description

The EHR allows the provider to select the patients that will be seen in the clinic for the day. Anita Francesca Marina is selected as the patient from this list and her record is opened in the EHR


Comments

No Comments


Pre-condition

Anita Francesca Marina and Juan Marcel Marina Initial Data Load completed.


Post-Condition

The set of patients that will be seen in the clinic for the day are selected and available for additional actions (e.g. query the registry). Anita Francesca Marina is selected as the active working patient in the EHR.


Test Objectives

Select One or More Patients: The EHR or other clinical software system must allow a provider to specify one or more patients in real time or those scheduled for appointment(s) in the future (e.g., the next day, week, month, etc.) so that a request can be sent to the public health immunization registry for each patient’s complete immunization history.


Evaluation Criteria

Anita Francesca Marina and Juan Marcel Marina are scheduled to be seen in the clinic on the selected day (day of test).

The EHR is able to select the list of patients scheduled to be seen on the day of the test. This list includes Anita Francesca Marina and Juan Marcel Marina. Anita Francesca Marina is selected from this list to proceed with the request for her vaccine history and recommendations.


Notes

The list of patients requested to be scheduled for this test must include Anita Francesca Marina and Juan Marcel Marina, but if other patients are scheduled for the day they should also be listed.

The co-located practices for Anita's PCP and Juan Marcel's pediatrician use the same system.


7.2.2. Query Registry for Anita Francesca Marina

Test Step Type: SUT_INITIATOR
Vendor SHALL be able to Generate a Z44 Query correctly and without omission according to supplied test data.

Test Story

Description

The provider uses the EHR to query the Immunization Registry for an Evaluated History and Vaccine Recommendations for an adult patient based on information known to the Immunization Registry.


Comments

No Comments


Pre-condition

Anita Francesca Marina Initial Data Load is completed.

Anita Francesca Marina is the active working patient in the EHR.


Post-Condition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for adult patient, Anita Francesca Marina.


Test Objectives

Request/Receipt of Patient Immunization History: The EHR or other clinical software system sends a request to the public health immunization registry "on demand," or in advance for those with scheduled appointments. The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother's maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Request Evaluated Immunization History and Forecast (Z44)  - HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

 

Note: Adult Patient


Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission  for the adult patient Anita Francesca Marina.

Tester shall verify that the data in the message corresponds to the data in the EHR and contains all test data attributes supplied.


Notes

The list of patients requested to be scheduled for this test must include Anita Francesca Marina and Juan Marcel Marina, but if other patients are scheduled for the day they should also be listed.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.4 Assigning Authority
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Marina Value-Test Case Fixed
QPD-4.2 Given Name Anita Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Francesca Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Ramirez Value-Test Case Fixed
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 19970601 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4623 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country USA
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type CP
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551213
QPD-10 Multiple birth indicator N Value-Test Case Fixed
QPD-11 Birth order

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1
RCP-2.2 Units
RCP-2.2.1 Identifier RD
RCP-2.2.2 Text Records
RCP-2.2.3 Name of Coding System HL70126

Test Data Specification

Patient Information
Element Data
Patient Name Anita Francesca Marina
Mother's Maiden Name Ramirez
ID Number 123456
Date/Time of Birth 06/01/1997
Sex Female
Patient Address 4623 Standish Way Stamford CT 06903 USA
Patient Phone (203)555-1213
Birth Indicator No
Birth Order

7.2.3. View and import response to request for vaccination history for adult patient Anita Francesca Marina

Test Step Type: TA_RESPONDER
The EHR displays the Immunization History results (Z42) returned in response to the Z44 Query and import them into the EHR for adult patient Anita Francesca Marina.

Test Story

Description

The physician accesses the record for adult patient Anita Francesca Marina and:

- Accepts the vaccines provided by the registry as the complete vaccination history for this patient had not yet been recorded in the EHR.


Comments

All historical vaccinations will be imported from the Z42 response.



Pre-condition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EHR and the response is available in the EHR for reconciliation and import. The provider has reviewed the patient-provided influenza vaccination and incorporated the vaccination information in the patient record. 


Post-Condition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (adult patient Anita Francesca Marina).


Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software system stores immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered historically as patient-reported, and which were accepted electronically from the public health registry.

Review Patient Immunization History: The EHR or other clinical software system displays vaccine history by vaccine series.

 

Note: Adult Patient


Evaluation Criteria

1. The EHR displays the information returned from the Immunization Registry according to the Juror Document.

2. The user imports all the vaccination given and the date administered returned from the immunization registry. 

Vaccinations Imported for adult patient:

measles, mumps, rubella, and varicella virus vaccine (MMRV) (CVX 94) administered 6/1/2018.

tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed (Adacel) (Tdap) (CVX 115) administered 6/1/2018.

influenza, recombinant, quadrivalent, injectable, preservative free (CVX 185) administered 9/1/2021


Note: Not available from the registry (available only to the EHR):

influenza, recombinant, quadrivalent, injectable, preservative free (CVX 185) administered 9/1/2022

Evidence of immunity to Hepatitis A is available from the EHR

Evidence of non-immunity to Hepatitis B is available from the EHR



Notes

No Note


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.4 Assigning Authority
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Marina
QPD-4.2 Given Name Anita
QPD-4.3 Second and Further Given Names or Initials Thereof Francesca
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Ramirez
QPD-5.7 Name Type Code L
QPD-6 PatientDateOfBirth
QPD-6.1 Time 19970601
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4623 Standish Way
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country USA
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type CP
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551213
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Marina
PID-5.2 Given Name Anita
PID-5.3 Second and Further Given Names or Initials Thereof Francesca
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 19970601
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4623 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197030
ORC-3.2 Namespace ID MPC
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier MPC
ORC-17.2 Text Metro Primary Care
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197030
ORC-3.2 Namespace ID MPC
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier MPC
ORC-17.2 Text Metro Primary Care
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197030
ORC-3.2 Namespace ID MPC
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier MPC
ORC-17.2 Text Metro Primary Care
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180601
RXA-5 Administered Code
RXA-5.1 Identifier 94
RXA-5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Mason
RXA-10.3 Given Name Jessica
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180601
RXA-5 Administered Code
RXA-5.1 Identifier 115
RXA-5.2 Text tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Mason
RXA-10.3 Given Name Jessica
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210901
RXA-5 Administered Code
RXA-5.1 Identifier 185
RXA-5.2 Text influenza, recombinant, quadrivalent,injectable, preservative free
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Mason
RXA-10.3 Given Name Jessica
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 94
OBX-5.2 Text measles, mumps, rubella, and varicella virus vaccine
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220901

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 94
OBX-5.2 Text tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220901

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 185
OBX-5.2 Text influenza, recombinant, quadrivalent,injectable, preservative free
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220901

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20220901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 115
OBX-5.2 Text tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20220601

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20230601
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Query the Registry for Anita Francesca Marina
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Anita Francesca Marina
Date of Birth 06/01/1997
Sex Female
Address 1
Street 4623 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Sophia Serena Ramirez
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Metro Primary Care
Vaccine Group measles, mumps, rubella, and varicella virus vaccine
Vaccine Administered measles, mumps, rubella, and varicella virus vaccine
Refusal Reason
Date/Time Administration-Start 06/01/2018
Date/Time Administration-End 06/01/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name Merck and Co Inc
Administration Notes
Administering Provider
Name Jessica Mason
ID Number
Administered-at Location
Facility ID MPC
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Metro Primary Care
Vaccine Group tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed
Vaccine Administered tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed
Refusal Reason
Date/Time Administration-Start 06/01/2018
Date/Time Administration-End 06/01/2018
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur
Administration Notes
Administering Provider
Name Jessica Mason
ID Number
Administered-at Location
Facility ID MPC
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Metro Primary Care
Vaccine Group influenza, recombinant, quadrivalent,injectable, preservative free
Vaccine Administered influenza, recombinant, quadrivalent,injectable, preservative free
Refusal Reason
Date/Time Administration-Start 09/01/2021
Date/Time Administration-End 09/01/2021
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Intramuscular
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur
Administration Notes
Administering Provider
Name Jessica Mason
ID Number
Administered-at Location
Facility ID MPC
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2022
Earliest Date to Give
Latest Date to Give
Date When Vaccine Overdue
Status in Immunization Series
Forecast Reason
Vaccine Group tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed
Vaccine Due Date 06/01/2023
Earliest Date to Give
Latest Date to Give
Date When Vaccine Overdue
Status in Immunization Series
Forecast Reason

7.2.4. View the vaccination recommendations for Anita Francesca Marina

Test Step Type: SUT_MANUAL
The EHR displays the vaccine recommendations for adult patient Anita Francesca Marina.

Test Story

Description

The physician accesses the record for Anita Francesca Marina and:

- Views the vaccine recommendations (as determined through EHR defined methods with consideration for both the IIS vaccine history and forecast and the information available through the EHR).

As a healthcare worker:

1. The EHR or other clinical software system indicates that given her immunity status of negative for Hepatitis B, that she should receive the Hepatitis B vaccination.

2. Anita has been identified to receive a new vaccine as a campaign for healthcare workers.


Comments

All historical vaccinations will be imported from the Z42 response.





Pre-condition

EHR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for adult patient Anita Francesca Marina').



Post-Condition

Adult vaccine recommendations based upon the imported vaccine history and information already available to the provider is available to the user.



Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient's newly updated immunization history. Forecasts are updated following reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service, but should reference the most recent recommendations.


Note: Recommendation for new vaccine; Vaccine Recommendation for Adult Patient


Evaluation Criteria

1. Tester verifies that the vendor can display the immunization recommendations based upon the adult patient's vaccination history, and risk factors of potential future pregnancy and as a healthcare worker.

2. Verify that the EHR includes in the vaccine recommendations:

New Coronavirus vaccine per campaign targeting Healthcare Workers
Hepatitis BRecommended for Healthcare Workers from EMR
Tdap booster June 1, 2023Per Immunization Registry recommendations
influenza, unspecified formulation due on Sept 1, 2023 or later
Per post-reconciled immunization recommendations

Notes

Healthcare worker-related vaccine recommendations are not returned from the registry since the registry does not maintain employment information.

Influenza does not have an overdue date. 

The due date must be in range for the date shown. Vaccine recommendation dates may vary and should accommodate differences in date handling.

Further variation should be documented in the notable exceptions, but minimally each forecast recommendation must be present.


7.3. Anita Francesca Marina, Enter Orders and Immunizations

Orders and Immunization events, non-administrations, and alerts presented for current visit.

Test Story

Description

This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients.


Comments

No Comments


Pre-condition

Anita Francesca Marina is entered as a patient in the EMR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Anita Francesca Marina Initial Data Load'.


Post-Condition

Visit orders are entered in Anita Francesca Marina's record.


Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine).

Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS.

Note: New vaccine, adult

Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

  - 2100: Indicates that any date field is in the future. Specific errors for date transmitted in an OBX are also provided.

  - 2102: Indicates that a VIS given date messaged in OBX-5 is in the future

  - 2103: Indicates that a VIS publication date messaged in OBX-5 is in the future

  - 2013: Indicates that the funding source code in an OBX segment conflicts with other data in the message (eligibility, age etc)

  - 2017: Indicates that the administration site is inconsistent with the vaccine administered


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


7.3.1. Vaccine Administration Data Quality Checks

Test Step Type: SUT_MANUAL
The provider attempts to document vaccine administration information for Anita Francesca Marina in the EHR. Vaccination data quality checks are verified during data entry.

Test Story

Description

The provider attempts to document vaccine administration information for the immunization for Anita Francesca Marina. These data quality checks primarily relate to improving vaccine administration information and associated observations that will be included when submitting data to the immunization registry.



Comments

Evaluates EHR functions for verifying data quality of vaccination data and associated observations used for reporting vaccinations to the immunization registry. There is no transaction associated with this test step.


Pre-condition

Order is placed for the Hepatitis B vaccine.



Post-Condition

The EHR has alerted the provider for each of the data quality checks verified for Anita Francesca Marina.



Test Objectives

Data Quality Checks: The EHR or other clinical software integrates additional data quality checks into IIP Testing and Recognition to improve data quality and reduce rejections.

Note: The EHR or other clinical software system prevents specific data issues which would potentially result in IIS errors as defined by the AIRA Error Codes. This supports reducing data quality issues that could trigger the following AIRA-defined Error Codes:

  - 2100: Indicates that any date field is in the future. Specific errors for date transmitted in an OBX are also provided.

  - 2102: Indicates that a VIS given date messaged in OBX-5 is in the future

  - 2103: Indicates that a VIS publication date messaged in OBX-5 is in the future

  - 2013: Indicates that the funding source code in an OBX segment conflicts with other data in the message (eligibility, age etc)

  - 2017: Indicates that the administration site is inconsistent with the vaccine administered





Evaluation Criteria

Evaluation Criteria: During the course of data entry for information below, the EHR triggers the following data quality issues:

  • Triggers Error that date is in the future (2100)
  • Triggers Error a VIS given date is in the future (2102)
  • Triggers Error that a VIS Publication date is in the future (2103)
  • Triggers Error that the funding source code conflicts with other data (2013)
  • Triggers Error that the administration site is inconsistent with the vaccine administered (2017)
Entered By
Jessica Mason

Ordering Provider
Shannon Price

Entering Organization
Metro Primary Care

Vaccine Event information source
New immunization record (NIP001 00)

Date/Time of Start of Administration
Current Date+1 day
Triggers Error that date is in the future (2100)
Will be corrected to current date
Vaccine Administered
hepatitis B vaccine, adult dosage (CVX 43)
 ENERGIX-B (58160-0821-05)

2D Barcode

GTIN
10358160821056

Administered Amount (of Vaccine)
1
Administered Units (of Measure)
mL

Administration Notes


Administering Provider
Jessica Mason

Administered-at Location
400 Shoreline Drive, Stamford Connecticut 06901

Lot Number
6942FL12

Substance Expiration Date
12/31/2023

Substance Manufacturer Name
GlaxoSmithKline Biologicals SA (MVX SKB)

Completion Status
Completed (CP)

Route of Administration
Intramuscular (NCIT: C28161, HL70162: IM)

Administration Site
Left Gluteus Medius(HL70163: LG)
Triggers Error that the administration site is inconsistent with the vaccine administered (2017)
 Will be corrected to Left Deltoid (HL70163 LD)
VFC Eligibility
No

Funding Source
VFCTriggers Error that the funding source code conflicts with other data (2013)
Will be corrected to ‘Private’
Dose
1 of 2

VIS Publication Date
12/01/2024
Triggers Error that a VIS Publication date is in the future (2103)
Will be corrected to 10/15/2021
VIS Given Date
12/01/2024
Triggers Error a VIS given date is in the future (2102)
Will be corrected to Current Date
VIS Fully Encoded Text-String
253088698300005911211015







Notes

The full vaccination details are provided here to facilitate the documentation constraints and/or screens that may be required by the vendor in order to attempt to document the data of interest, but these are not verified until the next step. Only those attributes specified that are anticipated to result in data quality alerts are required for this step.

If a system does not allow the entry of a future date for the date/time of administration, VIS Publication Date or the VIS Given Date this is acceptable for the purposes of data quality.






7.3.2. Record Vaccine Administration for Hepatitis B

Test Step Type: SUT_MANUAL
The EHR is able to document all attributes associated with the administration of Hepatitis B for an adult patient.

Test Story

Description

Since Anita is a healthcare worker with no evidence of immunity to Hepatitis B, the nurse administers a Hepatitis B vaccination to adult patient, Anita Francesca Marina:

- Documents all required information for the Hepatitis B vaccine



Comments

No Comments


Pre-condition

Order is placed for the Hepatitis B vaccine.


Post-Condition

The administration of the Hepatitis B vaccine  is recorded in the EHR.



Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine).

Record Vaccine Information by Scanning 2D Barcode Found on Unit-of-Use for Vaccine Administration: The EHR or other clinical software system allows users to record vaccination information from 2D barcodes (GS1 DataMatrix) found on unit-of-use (vial or pre-filled syringe) for each vaccine administered. This 2D barcode contains: the Global Trade Item Number (GTIN), expiration date and lot number. The GTIN contains the National Drug Code (NDC) and manufacturer data elements. Implementers can use mapping tables to determine the manufacturer from this NDC. The software system records these elements as structured data elements so the immunization administration message can use them to include the NDC and manufacturer in the message to the IIS.

Note: Adult Patient


Evaluation Criteria

The EHR or other clinical software system records the following vaccine administration information. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

The EHR records the following vaccine administration information, and using the 2D Barcode found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:

Entered By
Jessica Mason
Ordering Provider
Shannon Price
Entering Organization
Metro Primary Care
Vaccine Event information source
New immunization record (NIP001 00)
Date/Time of Start of Administration
Current Date
Vaccine Administered
hepatitis B vaccine, adult dosage (CVX 43)
ENERGIX-B (58160-0821-05)
2D Barcode
GTIN
10358160821056
Administered Amount (of Vaccine)
1
Administered Units (of Measure)
mL
Administration Notes

Administering Provider
Jessica Mason
Administered-at Location
400 Shoreline Drive, Stamford Connecticut 06901
Lot Number
6942FL12
Substance Expiration Date
12/31/2023
Substance Manufacturer Name
GlaxoSmithKline Biologicals SA (MVX SKB)
Completion Status
Completed (CP)
Route of Administration
Intramuscular (NCIT: C28161, HL70162: IM)
Administration Site
Left Deltoid (HL70163: LD)
VFC Eligibility
No
Funding Source
Private
Dose1 of 2
VIS Publication Date
10/15/2021
VIS Given Date
Current Date
VIS Fully Encoded Text-String
253088698300005911211015







Notes

The EHR does not need to specify a 'new immunization', as long as there is a way to indicate that it is a new immunization within the EHR, this is acceptable (e.g. the default interpretation of the data entry is that it is a new immunization and not historical).






7.3.3. Record Vaccine Administration for New Vaccine

Test Step Type: SUT_MANUAL
The EHR is able to document all attributes associated with the new vaccine administration for an adult patient.

Test Story

Description

The nurse administers the new vaccine to adult patient, Anita Francesca Marina:

- Documents all required information for the vaccine using the new vaccine information entered in the Manage Configuration test steps.




Comments

No Comments


Pre-condition

Order is placed for the newly available vaccine.



Post-Condition

The administration of the newly available vaccine  is recorded in the EHR.



Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, route of administration (e.g. intramuscular), site of administration (e.g., left arm), immunization type, lot number, manufacturer, Vaccine Information Statement date, quantity of vaccine/dose size and ordering clinician. The system also assures data quality, i.e., data entered are appropriate (e.g., avoid “oral” route for IM vaccines, and assure dose is appropriate for the vaccine).

 Note: Adult Patient




Evaluation Criteria

The EHR or other clinical software system records the following vaccine administration information. The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions:

The EHR records the following vaccine administration information, and using the 2D Barcode found on the Unit-of-Use for vaccine administration, automatically populates the Vaccine Type/product administered, the expiration date and the lot number:

Entered By
Jessica Mason
Ordering Provider
Shannon Price
Entering Organization
Metro Primary Care
Vaccine Event information source
New immunization record (NIP001 00)
Date/Time of Start of Administration
Current Date
Vaccine Administered
Pfizer-BioNTech Covid-19 Vaccine (CVX 208)
(NDC 59267-1000-01)
2D Barcode
See Notes
GTIN
00359267100016 (see notes)
Administered Amount (of Vaccine)
0.5
Administered Units (of Measure)
mL
Administration Notes

Administering Provider
Jessica Mason
Administered-at Location
400 Shoreline Drive, Stamford Connecticut 06901
Lot Number
8L7B3418
Substance Expiration Date
12/31/2023
Substance Manufacturer Name
Pfizer, Inc (MVX PFR)
Completion Status
Completed (CP)
Route of Administration
Intramuscular (NCIT: C28161, HL70162: IM)
Administration Site
Right Deltoid (HL70163: RD)
VFC Eligibility
No
Funding Source
Public
Dose
1 of 2
VIS Publication Date
12/08/2022
VIS Given Date
Current Date
VIS Fully Encoded Text-String
253088698300033211210501

Notes

The EHR does not need to specify a 'new immunization', as long as there is a way to indicate that it is a new immunization within the EHR, this is acceptable (e.g. the default interpretation of the data entry is that it is a new immunization and not historical).

The VIS Publication Date is not yet formalized for this vaccine, so may differ in tested product.

A GTIN for Pfizer-BioNTech COVID-19 Vaccine (PURPLE CAP) (NDC: NDC 59267-1000-01) had not yet been assigned at the time this test plan was generated. A GTIN was generated for the purpose of this test according to GS1 standards and may be updated in the future should this be changed in IIS: NDC Lookup Crosswalk published by CDC. The lack of an assigned GTIN also means a GS1 DataMatrix (2D barcode) was not created for this test plan. Vendors must therefore hand enter this vaccine information.





7.4. Anita Francesca Marina Transmit Immunization Report

Send the Immunization Report to the Immunization Registry (VXU/Z22) for Anita Francesca Marina.

Test Story

Description

Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EHR imported from the IIS.



Comments

No Comments


Pre-condition

The vaccines for the visit have been administered.


Post-Condition

The IIS has received the vaccine information (Z22 message).


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

 Note: Adult Patient


Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.

Note: Testing for NDC codes, CVX for immunizations.



Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


7.4.1. Transmit the Immunization Report for Anita Francesca Marina

Test Step Type: SUT_INITIATOR
The EHR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This includes all newly administered vaccines and may include historical information updated in the EHR during the visit. This also includes notification that Hepatitis B is not administered due to serological evidence of immunity.

Test Story

Description

Following the vaccinations given during the visit, the EHR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines, and an indication that Varicella was not administered due to a history of the disease as evidence of immunity. The Vaccination report also includes an indication that Hepatitis A was not administered due to serological evidence of immunity. The report MAY send the immunizations that the EHR imported from the IIS.


Comments

The Report must include all newly administered vaccines in any order. The report may include the information imported from the IIS.


Pre-condition

The vaccines for the visit have been administered. The clinical information has been documented for Anita Francesca Marina in the Initial Data Load.


Post-Condition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.

Note: Adult Patient

Link Standard Codes to Immunization Data: The EHR or other clinical software system links standard codes (i.e., LOINC for lab tests or evaluation tools, SNOMED CT for conditions or observations, NDC codes for current immunizations, CVX for historical immunizations, appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.

Note: Testing for NDC codes, CVX for immunizations.



Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

This includes indication that Hepatitis A was not administered due to serological evidence of immunity.


Notes

All NDC coded values are required to use the 11-Character format that includes dashes (‘-‘).



Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIPEHRFAC Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code XX Presence-Content Indifferent
MSH-22.10 Organization Identifier 100-1 Presence-Content Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIPIISFAC Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code XX Presence-Content Indifferent
MSH-23.10 Organization Identifier 100-2 Presence-Content Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].4 Assigning Authority
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].4 Assigning Authority
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Marina Value-Test Case Fixed
PID-5.2 Given Name Anita Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Francesca Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Ramirez Presence-Content Indifferent
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 19970601 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Value-Test Case Fixed
PID-10.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4623 Standish Way
PID-11.2 Other Designation
PID-11.3 City Stamford Value-Test Case Fixed
PID-11.4 State or Province CT Value-Test Case Fixed
PID-11.5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type L Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551213 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Value-Test Case Fixed
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-24 Multiple Birth Indicator N Value-Test Case Fixed
PID-25 Birth Order
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/Recall - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20131001 Presence Length-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20131001 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20131001 Presence-Content Indifferent

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197030
ORC-3.2 Namespace ID MPC
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Mason Presence-Content Indifferent
ORC-10.3 Given Name Jessica Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Price Presence-Content Indifferent
ORC-12.3 Given Name Shannon Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier MPC Presence-Content Indifferent
ORC-17.2 Text Metro Primary Care Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197030
ORC-3.2 Namespace ID MPC
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Mason Presence-Content Indifferent
ORC-10.3 Given Name Jessica Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Price
ORC-12.3 Given Name Shannon
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier MPC Presence-Content Indifferent
ORC-17.2 Text Metro Primary Care Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197030
ORC-3.2 Namespace ID MPC
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Mason Presence-Content Indifferent
ORC-10.3 Given Name Jessica Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Price Presence-Content Indifferent
ORC-12.3 Given Name Shannon Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier MPC Presence-Content Indifferent
ORC-17.2 Text Metro Primary Care Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197030
ORC-3.2 Namespace ID MPC
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Mason Presence-Content Indifferent
ORC-10.3 Given Name Jessica Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Jobs
ORC-12.3 Given Name John
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier MPC Presence-Content Indifferent
ORC-17.2 Text Metro Primary Care Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197030
ORC-3.2 Namespace ID MPC
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Mason Presence-Content Indifferent
ORC-10.3 Given Name Jessica Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Price
ORC-12.3 Given Name Shannon
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier MPC Presence-Content Indifferent
ORC-17.2 Text Metro Primary Care Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197030
ORC-3.2 Namespace ID MPC
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Mason Presence-Content Indifferent
ORC-10.3 Given Name Jessica Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Price
ORC-12.3 Given Name Shannon
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier MPC Presence-Content Indifferent
ORC-17.2 Text Metro Primary Care Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID OP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Mason Presence-Content Indifferent
ORC-10.3 Given Name Jessica Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Price
ORC-12.3 Given Name Shannon
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.10 Name Type Code L
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier MPC Presence-Content Indifferent
ORC-17.2 Text Metro Primary Care Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Presence-Content Indifferent

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180601 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 94 Value-Test Case Fixed
RXA-5.2 Text measles, mumps, rubella, and varicella virus vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Mason Presence-Content Indifferent
RXA-10.3 Given Name Jessica
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6552FK16
RXA-16 Substance Expiration Date
RXA-16.1 Time 20181231
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck and Co Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180601 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 115 Value-Test Case Fixed
RXA-5.2 Text tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Mason Presence-Content Indifferent
RXA-10.3 Given Name Jessica
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6932FK14
RXA-16 Substance Expiration Date
RXA-16.1 Time 20181231
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20210901 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 185 Value-Test Case Fixed
RXA-5.2 Text influenza, recombinant, quadrivalent,injectable, preservative free Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Mason Presence-Content Indifferent
RXA-10.3 Given Name Jessica Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6475FK21 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20211231 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text Sanofi Pasteur Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20220901 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 185 Value-Test Case Fixed
RXA-5.2 Text influenza, recombinant, quadrivalent,injectable, preservative free Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 02 Value-Test Case Fixed
RXA-9.2 Text Historical information - from other provider
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Muir Presence-Content Indifferent
RXA-10.3 Given Name Sophia
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 8L4B3423
RXA-16 Substance Expiration Date
RXA-16.1 Time 20221231
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 208 Value-Test Case Fixed
RXA-5.2 Text Pfizer-BioNTech COVID-19 Vaccine Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Mason Presence-Content Indifferent
RXA-10.3 Given Name Jessica
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 8L7B3418
RXA-16 Substance Expiration Date
RXA-16.1 Time 20231231
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20221031 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 43 Value-Test Case Fixed
RXA-5.2 Text hepatitis B vaccine, adult dosage Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 1
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Mason Presence-Content Indifferent
RXA-10.3 Given Name Jessica
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number 6942FL12
RXA-16 Substance Expiration Date
RXA-16.1 Time 20231231
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20180515 Value-Test Case Fixed
RXA-5 Administered Code
RXA-5.1 Identifier 998 Value-Test Case Fixed
RXA-5.2 Text No vaccine administered Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-20 Completion Status NA Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text Intramuscular
RXR-1.3 Name of Coding System NCIT
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document Type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300033211210501
OBX-5.2 Text COVID-19 Pfizer BioNTech EUA Recipient-Caregiver Fact Sheet-12 years and older
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS Presentation Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7
OBX-3.2 Text vaccine fund pgm elig cat
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC elig
OBX-5.3 Name of Coding System HL70064
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3
OBX-3.2 Text Vaccine funding source
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier VXC50
OBX-5.2 Text Public funds
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document Type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300005911211015
OBX-5.2 Text Hepatitis B Vaccine VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS Presentation Date
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20221031
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7
OBX-3.2 Text vaccine fund pgm elig cat
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC elig
OBX-5.3 Name of Coding System HL70064
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3
OBX-3.2 Text Vaccine funding source
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier PHC70
OBX-5.2 Text Private funds
OBX-5.3 Name of Coding System CDCPHINVS
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20221031
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 52
OBX-5.2 Text hepatitis A vaccine, adult dosage
OBX-5.3 Name of Coding System CVX
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180515
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 75505-8
OBX-3.2 Text Diseases with serological evidence of immunity
OBX-3.3 Name of Coding System LN
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 278971009
OBX-5.2 Text Serology confirmed hepatitis A
OBX-5.3 Name of Coding System SCT
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20180515
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Anita Francesca Marina
Mother's Maiden Name Sophia Ramirez
ID Number 123456 987633
Date/Time of Birth 06/01/1997
Administrative Sex Female
Patient Address 4623 Standish Way Stamford CT 06903 USA
Local Number (203)555-1213
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator No
Birth Order
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 10/01/2013
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 10/01/2013
Protection Indicator No
Protection Indicator Effective Date 10/01/2013
Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 06/01/2018
Administered Amount 0.5
Administered Units
Administration Notes
Administering Provider Jessica Mason
Substance Lot Number 6552FK16
Substance Expiration Date 12/31/2018
Substance Manufacturer Name Merck and Co Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Metro Primary Care
Entered By Jessica Mason
Ordered By Shannon Price

Vaccine Administration Information
Element Data
Administered Vaccine tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed
Date/Time Start of Administration 06/01/2018
Administered Amount 0.5
Administered Units
Administration Notes
Administering Provider Jessica Mason
Substance Lot Number 6932FK14
Substance Expiration Date 12/31/2018
Substance Manufacturer Name Sanofi Pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Metro Primary Care
Entered By Jessica Mason
Ordered By Shannon Price

Vaccine Administration Information
Element Data
Administered Vaccine influenza, recombinant, quadrivalent,injectable, preservative free
Date/Time Start of Administration 09/01/2021
Administered Amount 0.5
Administered Units
Administration Notes
Administering Provider Jessica Mason
Substance Lot Number 6475FK21
Substance Expiration Date 12/31/2021
Substance Manufacturer Name Sanofi Pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Metro Primary Care
Entered By Jessica Mason
Ordered By Shannon Price

Vaccine Administration Information
Element Data
Administered Vaccine influenza, recombinant, quadrivalent,injectable, preservative free
Date/Time Start of Administration 09/01/2022
Administered Amount 0.5
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Sophia Muir
Substance Lot Number 8L4B3423
Substance Expiration Date 12/31/2022
Substance Manufacturer Name Sanofi Pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Right Deltoid
Entering Organization Metro Primary Care
Entered By Jessica Mason
Ordered By John Jobs

Vaccine Administration Information
Element Data
Administered Vaccine Pfizer-BioNTech COVID-19 Vaccine
Date/Time Start of Administration 10/31/2022
Administered Amount 0.5
Administered Units
Administration Notes
Administering Provider Jessica Mason
Substance Lot Number 8L7B3418
Substance Expiration Date 12/31/2023
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Right Deltoid
Entering Organization Metro Primary Care
Entered By Jessica Mason
Ordered By Shannon Price

Element Data
Document Type COVID-19 Pfizer BioNTech EUA Recipient-Caregiver Fact Sheet-12 years and older
VIS Presentation Date 10/31/2022
vaccine fund pgm elig cat Not VFC elig
Vaccine funding source Public funds

Vaccine Administration Information
Element Data
Administered Vaccine hepatitis B vaccine, adult dosage
Date/Time Start of Administration 10/31/2022
Administered Amount 1
Administered Units
Administration Notes
Administering Provider Jessica Mason
Substance Lot Number 6942FL12
Substance Expiration Date 12/31/2023
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization Metro Primary Care
Entered By Jessica Mason
Ordered By Shannon Price

Element Data
Document Type Hepatitis B Vaccine VIS
VIS Presentation Date 10/31/2022
vaccine fund pgm elig cat Not VFC elig
Vaccine funding source Private funds

Vaccine Administration Information
Element Data
Administered Vaccine No vaccine administered
Date/Time Start of Administration 05/15/2018
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status Not Administered
Action Code Add
Route
Administration Site
Entering Organization Metro Primary Care
Entered By Jessica Mason
Ordered By Shannon Price

Element Data
vaccine type hepatitis A vaccine, adult dosage
Diseases with serological evidence of immunity Serology confirmed hepatitis A

7.4.2. Receive ACK Z23 from Immunization Registry

Test Step Type: TA_RESPONDER
The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Test Story

Description

The Immunization Registry returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.


Comments

No Comments


Pre-condition

A VXU message is generated by the EHR.


Post-Condition

The ACK Z23 is received by the EHR.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's newly administered or newly identified immunization history to public health immunization registries.


Evaluation Criteria

The acknowledgement message is consumed by the system responsible for the content of the administration message without error.


Notes

Important note regarding the MSH-10 and MSA-2: The NIST acknowledgment message is predefined and is based on the VXU message. Most systems will automatically create the message control Identifier and may require it for importing, linking, and processing the ACK message. The NIST ACK test message can be modified such that MSA-2 matches MSH-10 of the VXU message generated by the system-under test.


Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NISTIISAPP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NISTIISFAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NISTEHRAPP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NISTEHRFAC
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20221031073734.034-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID NIST-IZ-AD-1.2_Receive_ACK_Z23
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NISTIISFAC
MSH-22.6 Assigning Authority
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NISTEHRFAC
MSH-23.6 Assigning Authority
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-AD-1.1_Send_V04_Z22

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

8. Review Inventory

Demonstrates the ability to view inventory supply, including deprecated inventory used.

Test Story

Description

Comments

Pre-condition

Post-Condition

Test Objectives

Evaluation Criteria

Notes

8.1. View Inventory

Demonstrates the ability to view updated inventory supply.

Test Story

Description

The provider reviews the available inventory following vaccine administrations used during the day.


Comments

No Comments


Pre-condition

Vaccine inventory entered.

Vaccines administered for Juana Mariana Vazquez, Juan Marcel Marina, Juana Maria Gonzales, and Anita Francesca Marina.


Post-Condition

Available vaccine inventory displayed.


Test Objectives

Update Vaccine Inventory from Patient Dosage Administration: The EHR or other clinical software system updates the vaccine inventory to ensure the correct count of remaining available vaccine inventory.


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


8.1.1. View updated vaccine inventory

Test Step Type: SUT_MANUAL
Demonstrates the ability to view updated inventory supply.

Test Story

Description

The provider reviews the available inventory following vaccine administrations used during the day.


Comments

No Comments


Pre-condition

Vaccine inventory entered.

Vaccines administered for Juana Mariana Vazquez, Juan Marcel Marina, Juana Maria Gonzales, and Anita Francesca Marina.


Post-Condition

Available vaccine inventory displayed.


Test Objectives

Update Vaccine Inventory from Patient Dosage Administration: The EHR or other clinical system updates the vaccine inventory to ensure the correct count of remaining available vaccine inventory.


Evaluation Criteria

The EHR inventory shows (minimally):


Item 1
 

Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0890-41
Product Name:
FLUARIX QUADRIVALENT
Lot#:
8L4B3521
Expiration Date:
12/31/2023
GTIN:
10358160890410
Vaccine source:
VFC
Quantity:
11
Presentation:
Prefilled syringe (PFS)


Item 2
 

Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0890-41
Product Name:
FLUARIX QUADRIVALENT
Lot#:
D8043IN8422
Expiration Date:
12/31/2023
GTIN:
10358160890410
Vaccine source:
VFC
Quantity:
14
Presentation:
Prefilled syringe (PFS)
2D Barcode:



Item 3
 

Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0890-41
Product Name:
FLUARIX QUADRIVALENT
Lot#:
D8043IN8855
Expiration Date:
12/31/2023
GTIN:
10358160890410
Vaccine source:
VFC
Quantity:
11
Presentation:
Prefilled syringe (PFS)


Item 4
 

Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0820-43
Product Name:
ENGERIX-B
Lot#:
6332FK18
Expiration Date:
06/15/2022
GTIN:
10358160820431
Vaccine source:
Non-VFC
Quantity:
18
Presentation:
Prefilled syringe (PFS)


Item 5
 

Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0820-43
Product Name:
ENGERIX-B
Lot#:
6332FK26
Expiration Date:
12/31/2023
GTIN:
10358160820431
Vaccine source:
Non-VFC
Quantity:
19
Presentation:
Prefilled syringe (PFS)


Item 6
 

Use (Vial or Syringe)
Labeler:

NDC:
58160-0811-43
Product Name:
Pediarix
Lot#:
6559FK32


Expiration Date:
12/31/2023
GTIN:
10358160811439
Vaccine source:
Non-VFC
Quantity:
15
Presentation:
Prefilled syringe (PFS)


Item 7
 

Use (Vial or Syringe)
Labeler:
Pfizer Manufacturing Belgium NV
NDC:
59267-1000-01
Product Name:
Pfizer-BioNTech Covid-19 Vaccine
Lot#:
8L7B3418
Expiration Date:
12/31/2023
GTIN:
00359267100016
Vaccine source:
Non-VFC
Quantity (doses):
449
Presentation:
Multi-use vials


Item 8


Use (Vial or Syringe)
Labeler:
GlaxoSmithKline Biologicals SA
NDC:
58160-0821-05
Product Name:
ENGERIX-B (adult)
Lot#:
6942FL12
Expiration Date:
12/31/2023
GTIN:
10358160821056
Vaccine source:
Non-VFC
Quantity:
15
Presentation:
Prefilled syringe (PFS)




Notes

Because the influenza season may not align with the test plan execution, the most current influenza vaccine may not be present.


8.2. Produce Inventory Report of Remaining Stock

Demonstrates the ability to generate a stock report that lists all vaccines in stock, sorted by expiration date and another sorted by source (private vs VFC stock).

Test Story

Description

The provider periodically uses the EHR to review inventory of remaining stock. The report may be sorted by expiration date or funding source.


Comments

No Comments


Pre-condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Vaccines administered in previous test steps have been deprecated from stock record. 


Post-Condition

The Cohort report for all inventory stock is available to the provider through the EHR, sorted by funding source and expiration date.


Test Objectives

Produce Vaccine History Report: The EHR or other clinical software system generates inventory reports of remaining stock. The reports can be sorted by expiration date and source (e.g., private or guarantee program). 


Evaluation Criteria

Evaluation criteria is defined within each test step.


Notes

No Note


8.2.1. Produce Stock Inventory Report - Expiration Date Sort

Test Step Type: SUT_MANUAL
The provider uses the EHR to create a report for vaccine stock inventory sorted by expiration date.

Test Story

Description

The provider periodically uses the EHR to review the stock inventory sorted by the expiration date to inform orders for new vaccine stock. 


Comments

No Comments


Pre-condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Vaccines administered in previous test steps have been deprecated from stock record. 


Post-Condition

The Cohort report for all inventory stock is available to the provider through the EHR, sorted by expiration date.


Test Objectives

Produce Vaccine History Report: The EHR or other clinical software software system generates inventory reports of remaining stock. The reports can be sorted by expiration date and source (e.g., private or guarantee program). 


Evaluation Criteria

The following information is (minimally) provided on the inventory report, sorted by expiration date

Item 1 

Use (Vial or Syringe)
Labeler:GlaxoSmithKline Biologicals SA
NDC:58160-0820-43
Product Name:ENGERIX-B
Lot#:6332FK18
Expiration Date:06/15/2022
GTIN:10358160820431
Vaccine source:Non-VFC
Quantity:18
Presentation:Prefilled syringe (PFS)


Item 2 

Use (Vial or Syringe)
Labeler:GlaxoSmithKline Biologicals SA
NDC:58160-0890-41
Product Name:FLUARIX QUADRIVALENT
Lot#:8L4B3521
Expiration Date:12/31/2023
GTIN:10358160890410
Vaccine source:VFC
Quantity:11
Presentation:Prefilled syringe (PFS)


Item 3 

Use (Vial or Syringe)
Labeler:GlaxoSmithKline Biologicals SA
NDC:58160-0890-41
Product Name:FLUARIX QUADRIVALENT
Lot#:D8043IN8422
Expiration Date:12/31/2023
GTIN:10358160890410
Vaccine source:VFC
Quantity:14
Presentation:Prefilled syringe (PFS)


Item 4 

Use (Vial or Syringe)
Labeler:GlaxoSmithKline Biologicals SA
NDC:58160-0890-41
Product Name:FLUARIX QUADRIVALENT
Lot#:D8043IN8855
Expiration Date:12/31/2023
GTIN:10358160890410
Vaccine source:VFC
Quantity:12
Presentation:Prefilled syringe (PFS)


Item 5 

Use (Vial or Syringe)
Labeler:GlaxoSmithKline Biologicals SA
NDC:58160-0820-43
Product Name:ENGERIX-B
Lot#:6332FK26
Expiration Date:12/31/2023
GTIN:10358160820431
Vaccine source:Non-VFC
Quantity:20
Presentation:Prefilled syringe (PFS)


Item 6 

Use (Vial or Syringe)
Labeler:
NDC:58160-0811-43
Product Name:Pediarix
Lot#:6559FK32
Serial#:
Expiration Date:12/31/2023
GTIN:10358160811439
Vaccine source:Non-VFC
Quantity:16
Presentation:Prefilled syringe (PFS)


Item 7 

Use (Vial or Syringe)
Labeler:Pfizer Manufacturing Belgium NV
NDC:59267-1000-01
Product Name:Pfizer-BioNTech Covid-19 Vaccine
Lot#:8L7B3418
Expiration Date:12/31/2023
GTIN:00359267100016
Vaccine source:Non-VFC
Quantity (doses):449
Presentation:Multi-use vials


Item 8

Use (Vial or Syringe)
Labeler:GlaxoSmithKline Biologicals SA
NDC:58160-0821-05
Product Name:ENGERIX-B (adult)
Lot#:6942FL12
Expiration Date:12/31/2023
GTIN:10358160821056
Vaccine source:Non-VFC
Quantity:15
Presentation:Prefilled syringe (PFS)



Notes

Because the influenza season may not align with the test plan execution, the most current influenza vaccine may not be present.


8.2.2. Produce Stock Inventory Report - Funding Source Sort

Test Step Type: SUT_MANUAL
The provider uses the EHR to create a report for vaccine stock inventory sorted by funding source.

Test Story

Description

The provider periodically uses the EHR to review the stock inventory sorted by funding source to inform orders for new vaccine stock. 


Comments

No Comments


Pre-condition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Vaccines administered in previous test steps have been deprecated from stock record. 


Post-Condition

The Cohort report for all inventory stock is available to the provider through the EHR, sorted by funding source.


Test Objectives

Produce Vaccine History Report: The EHR or other clinical software system generates inventory reports of remaining stock. The reports can be sorted by expiration date and source (e.g., private or guarantee program). 


Evaluation Criteria

The following information is (minimally) provided on the inventory report, sorted by funding source:

Item 1 

Use (Vial or Syringe)
Labeler:GlaxoSmithKline Biologicals SA
NDC:58160-0890-41
Product Name:FLUARIX QUADRIVALENT
Lot#:8L4B3521
Expiration Date:12/31/2023
GTIN:10358160890410
Vaccine source:VFC
Quantity:11
Presentation:Prefilled syringe (PFS)


Item 2 

Use (Vial or Syringe)
Labeler:GlaxoSmithKline Biologicals SA
NDC:58160-0890-41
Product Name:FLUARIX QUADRIVALENT
Lot#:D8043IN8422
Expiration Date:12/31/2023
GTIN:10358160890410
Vaccine source:VFC
Quantity:14
Presentation:Prefilled syringe (PFS)


Item 3 

Use (Vial or Syringe)
Labeler:GlaxoSmithKline Biologicals SA
NDC:58160-0820-43
Product Name:ENGERIX-B
Lot#:6332FK18
Expiration Date:06/15/2022
GTIN:10358160820431
Vaccine source:Non-VFC
Quantity:18
Presentation:Prefilled syringe (PFS)


Item 4 

Use (Vial or Syringe)
Labeler:GlaxoSmithKline Biologicals SA
NDC:58160-0890-41
Product Name:FLUARIX QUADRIVALENT
Lot#:D8043IN8855
Expiration Date:12/31/2023
GTIN:10358160890410
Vaccine source:VFC
Quantity:12
Presentation:Prefilled syringe (PFS)


Item 5 

Use (Vial or Syringe)
Labeler:GlaxoSmithKline Biologicals SA
NDC:58160-0820-43
Product Name:ENGERIX-B
Lot#:6332FK26
Expiration Date:12/31/2023
GTIN:10358160820431
Vaccine source:Non-VFC
Quantity:20
Presentation:Prefilled syringe (PFS)


Item 6 

Use (Vial or Syringe)
Labeler:
NDC:58160-0811-43
Product Name:Pediarix
Lot#:6559FK32


Expiration Date:12/31/2023
GTIN:10358160811439
Vaccine source:Non-VFC
Quantity:16
Presentation:Prefilled syringe (PFS)


Item 7 

Use (Vial or Syringe)
Labeler:Pfizer Manufacturing Belgium NV
NDC:59267-1000-01
Product Name:Pfizer-BioNTech Covid-19 Vaccine
Lot#:8L7B3418
Expiration Date:12/31/2023
GTIN:00359267100016
Vaccine source:Non-VFC
Quantity (doses):449
Presentation:Multi-use vials


Item 8

Use (Vial or Syringe)
Labeler:GlaxoSmithKline Biologicals SA
NDC:58160-0821-05
Product Name:ENGERIX-B (adult)
Lot#:6942FL12
Expiration Date:12/31/2023
GTIN:10358160821056
Vaccine source:Non-VFC
Quantity:15
Presentation:Prefilled syringe (PFS)

Notes

Because the influenza season may not align with the test plan execution, the most current influenza vaccine may not be present.